***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To examine the impact of a personal health record ( PHR ) in patients with hypertension measured by changes in biological outcomes , patient empowerment , patient perception of quality of care , and use of medical services . METHODS A cluster-r and omized effectiveness trial with PHR and no PHR groups was conducted in two ambulatory clinics . 453 of 1686 ( 26.4 % ) patients approached were included in the analyses . A PHR tethered to the patient 's electronic medical record ( EMR ) was the primary intervention and included security measures , patient control of access , limited transmission of EMR data , blood pressure ( BP ) tracking , and appointment assistance . BP was the main outcome measure . Patient empowerment was assessed using the Patient Activation Measure and Patient Empowerment Scale . Quality of care was assessed using the Clinician and Group Assessment Score ( CAHPS ) and the Patient Assessment of Chronic Illness Care . Frequency of use of medical services was self-reported . RESULTS No impact of the PHR was observed on BP , patient activation , patient perceived quality , or medical utilization in the intention-to-treat analysis . Sub- analysis of intervention patients self-identified as active PHR users ( 25.7 % of those with available information ) showed a 5.25-point reduction in diastolic BP . Younger age , self-reported computer skills , and more positive provider communication ratings were associated with frequency of PHR use . CONCLUSIONS Few patients provided with a PHR actually used the PHR with any frequency . Thus simply providing a PHR may have limited impact on patient BP , empowerment , satisfaction with care , or use of health services without additional education or clinical intervention design ed to increase PHR use . CLINICAL TRIAL REGISTRATION NUMBER http:// Clinical Trials.gov Identifier : NCT01317537 CONTEXT Despite the availability of efficacious treatments , the long-term course of bipolar disorder is often unfavorable . OBJECTIVE To test the effectiveness of a multicomponent intervention program to improve the quality of care and long-term outcomes for persons with bipolar disorder . DESIGN R and omized controlled trial with allocation concealment and blinded outcome assessment . SETTING Mental health clinics of a group-model prepaid health plan . PATIENTS Of 785 patients in treatment for bipolar disorder who were invited to participate , 509 attended an evaluation appointment , 450 were found eligible to participate , and 441 enrolled in the trial . INTERVENTIONS Participants were r and omly assigned to a multicomponent intervention program or to continued care as usual . Three nurse care managers provided a 2-year systematic intervention program , including the following : a structured group psychoeducational program , monthly telephone monitoring of mood symptoms and medication adherence , feedback to treating mental health providers , facilitation of appropriate follow-up care , and as-needed outreach and crisis intervention . MAIN OUTCOME MEASURES In-person blinded research interviews every 3 months assessed mood symptoms using the Longitudinal Interval Follow-up Examination . Health plan administrative records were used to assess the use and cost of mental health services . RESULTS Intent-to-treat analyses demonstrated that the intervention significantly reduced the mean level of mania symptoms ( z = 2.09 , P = .04 ) and the time with significant mania symptoms ( 19.2 vs 24.7 weeks ; F(1 ) = 6.0 , P = .01 ) . There was no significant intervention effect on mean level of depressive symptoms ( z = 0.19 , P = .85 ) or time with significant depressive symptoms ( 47.6 vs 50.7 weeks ; F(1 ) = 0.56 , P = .45 ) . Benefits of the intervention were found only in a subgroup of 343 persons with clinical ly significant mood symptoms  at the baseline assessment . The incremental cost ( adjusted ) of the intervention was 1251 dollars ( 95 % confidence interval , 55 - 2446 dollars ) , including approximately 800 dollars for the intervention program services and an approximate 500 dollars increase in the costs of other mental health services . CONCLUSIONS Population -based systematic care programs can significantly reduce the frequency and severity of mania in bipolar disorder , and cost increases are modest considering the clinical gains . The incorporation of more specific cognitive and behavioral content or more effective medication regimens may be necessary to significantly reduce the symptoms of depression CONTEXT Chronic pain is common in primary care patients and is associated with distress , disability , and increased health care use . OBJECTIVE To assess whether a collaborative intervention can improve chronic pain-related outcomes , including comorbid depression severity , in a Department of Veterans Affairs primary care setting . DESIGN , SETTING , AND PARTICIPANTS Cluster r and omized controlled trial of a collaborative care assistance with pain treatment intervention vs treatment as usual  at 5 primary care clinics of 1 Department of Veterans Affairs Medical Center . Forty-two primary care clinicians were r and omized to the assistance with pain treatment intervention group or the treatment as usual group . The 401 patients had musculoskeletal pain diagnoses , moderate or greater pain intensity , and disability lasting 12 weeks or longer and were assigned to the same treatment groups as their clinicians . Recruitment occurred from January 2006 to January 2007 and follow-up concluded in January 2008 . INTERVENTION Assistance with pain treatment included a 2-session clinician education program , patient assessment , education and activation , symptom monitoring , feedback and recommendations to clinicians , and facilitation of specialty care . MAIN OUTCOME MEASURES Changes over 12 months in pain-related disability ( Rol and -Morris Disability Question naire , range of 0 - 24 ) , pain intensity ( Chronic Pain Grade [ CPG ] Pain Intensity subscale , range of 0 - 100 ) , and depression ( Patient Health Question naire 9 [ PHQ-9 ] , range of 0 - 27 ) , measured as beta coefficients ( difference in slopes in points per month ) . RESULTS Intervention patients had a mean ( SD ) of 10.6 ( 4.5 ) contacts with the assistance with pain treatment team . Compared with the patients receiving treatment as usual , intervention patients showed greater improvements in pain-related disability ( Rol and -Morris Disability Question naire beta , -0.101 [ 95 % confidence interval { CI } , -0.163 to -0.040 ] ; P = .004 and CPG Pain Intensity subscale beta , -0.270 [ 95 % CI , -0.480 to -0.061 ] ; P = .01 ) . Among patients with baseline depression ( PHQ-9 score > or = 10 ) , there was greater improvement in depression severity in patients receiving the intervention compared with patients receiving treatment as usual ( PHQ-9 beta , -0.177 [ 95 % CI , -0.295 to -0.060 ] ; P = .003 ) . The differences in scores between baseline and 12 months for the assistance with pain treatment intervention group and the treatment as usual group , respectively , were -1.4 vs -0.2 for the Rol and -Morris Disability Question naire , -4.7 vs -0.6 for the CPG Pain Intensity subscale , and -3.7 vs -1.2 for PHQ-9 . CONCLUSION The assistance with pain treatment collaborative intervention result ed in modest but statistically significant improvement in a variety of outcome measures . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00129480 BACKGROUND Older persons who re hospitalized for acute illnesses often lose their independence and are discharged to institutions for long-term care . METHODS We studied 651 patients 70 years of age or older who were admitted for general medical care at a teaching hospital ; these patients were r and omly assigned to receive usual care or to be cared for in a special unit design ed to help older persons maintain or achieve independence in self-care activities . The key elements of this program were a specially prepared environment ( with , for example , uncluttered hallways , large clocks and calendars , and h and rails ) ; patient-centered care emphasizing independence , including specific protocol s for prevention of disability and for rehabilitation ; discharge planning with the goal of returning the patient to his or her home ; and intensive review of medical care to minimize the adverse effects of procedures and medications . The main outcome we measured ws the change from admission to discharge in the number of five basic activities of daily living ( bathing , getting dressed , using the toilet , moving from a bed to a chair , and eating ) that the patient could perform independently . RESULTS Twenty-four patients in each group died in the hospital . At the time of discharge , 65 ( 21 percent ) of the 303 surviving patients in the intervention group were classified as much better in terms of their ability to perform basic activities of daily living , 39 ( 13 percent ) as better , 151 ( 50 percent ) as unchanged , 22 ( 7 percent ) as worse , and 26 ( 9 percent ) as much worse . In the usual care group , 40 ( 13 percent ) of the 300 surviving patients were classified as much better , 33 ( 11 percent ) as better , 163 ( 54 percent ) as unchanged , 39 ( 13 percent ) as worse , and 25 ( 8 percent ) as much worse ( P = 0.009 ) . The difference between the groups remained significant ( P = 0.04 ) in a multivariable model in which we controlled for potentially confounding base-line characteristics of the patients . Lengths of stay and hospital charges were similar in the two groups . Fewer patients assigned to the intervention group were discharged to long-term care institutions ( 43 patients [ 14 percent ] , as compared with 67 patients [ 22 percent ] in the usual-care group ; P = 0.01 ) . Among the 493 patients discharged to private homes , similar proportions ( about 10 percent ) in the two groups were admitted to long-term care institutions during the three months after discharge . CONCLUSIONS Specific changes in the provision of acute hospital care can improve the ability of a heterogeneous group of acutely ill older patients to perform basic activities of daily living at the time of discharge from the hospital and can reduce the frequency of discharge to institutions for long-term care Hospital admissions due to chronic obstructive pulmonary disease ( COPD ) exacerbations have a major impact on the disease evolution and costs . The current authors postulated that a simple and well-st and ardised , low-intensity integrated care intervention can be effective to prevent such hospitalisations . Therefore , 155 exacerbated COPD patients ( 17 % females ) were recruited after hospital discharge from centres in Barcelona ( Spain ) and Leuven ( Belgium ) . They were r and omly assigned to either integrated care ( IC ; n = 65 ; age mean±sd 70±9 yrs ; forced expiratory volume in one second ( FEV1 ) 1.1±0.5 L , 43 % predicted ) or usual care ( UC ; n = 90 ; age 72±9 yrs ; FEV1 1.1±0.05 L , 41 % pred ) . The IC intervention consisted of an individually tailored care plan upon discharge shared with the primary care team , as well as accessibility to a specialised nurse case manager through a web-based call centre . After 12 months ’ follow-up , IC showed a lower hospitalisation rate ( 1.5±2.6 versus 2.1±3.1 ) and a higher percentage of patients without re-admissions ( 49 versus 31 % ) than UC without differences in mortality ( 19 versus 16 % , respectively ) . In conclusion , this trial demonstrates that a st and ardised integrated care intervention , based on shared care arrangements among different levels of the system with support of information technologies , effectively prevents hospitalisations for exacerbations in chronic obstructive pulmonary disease patients OBJECTIVE To assess the impact of patient-centered communication ( PCC ) behaviors on patients '  evaluations of physicians and acceptance of clinical recommendations . METHODS We r and omized 248 patients to view video-recorded , st and ardized vignettes , depicting a  cardiologist  using a high vs. low degree of PCC while recommending bypass surgery to a patient with angina and 3-vessel coronary artery disease . We compared patients ' ratings of the physician and their decision making in response to the physician 's recommendation , for high vs. low PCC vignettes . RESULTS Patients viewing high PCC vignettes rated the video physician more favorably overall ( 3.01 vs. 2.12 , p<0.001 ) and as more competent ( 3.22 vs. 2.66 , p<0.001 ) and trustworthy ( 2.93 vs. 2.28 , p<0.001 ) than those viewing the low PCC version ( 0 - 4 range for all scales ) . Patients viewing the high PCC version more frequently said they would undergo bypass surgery ( 96 % vs. 74 % , p<0.001 ) if they were the patient in the video . CONCLUSION Patients expressed greater confidence in physicians who used more  PCC behaviors , and greater willingness to accept an evidence -based recommendation . PRACTICE IMPLICATION S PCC may make physicians more effective in the delivery of evidence -based care CONTEXT There are few r and omized controlled trials on the effectiveness of palliative care interventions to improve the care of patients with advanced cancer . OBJECTIVE To determine the effect of a nursing-led intervention on quality of life , symptom intensity , mood , and re source use in patients with advanced cancer . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial conducted from November 2003 through May 2008 of 322 patients 
    Output:
    
The findings indicated that most interventions were based on the notion of empowering care and included attempts to educate consumers or prompt them about how to manage a health consultation .
Other common interventions focused on training providers in delivering empowering care .
Although it was difficult to draw firm conclusions because of the moderate to high risk of bias of the research design s , this review has shown some promising findings from implementing a patient-centered care approach .
There appeared to be benefits associated with this model of care in terms of patient satisfaction and perceived quality of care