***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: In their review of the different models of integrated care tried in Quebec over the last decade , the authors mention the PRISMA experiment and report that “ the results on impact on functional decline were inconclusive ” [ 2 , p. 5 ] . This is not true since the main outcome of this four-year quasi-experimental study involving more than 1500 subjects was a statistically significant 6.2 % reduction in the prevalence of functional decline ( p<0.05 ) and a 13.7 % decrease in the incidence of functional decline ( p<0.01 ) in the experimental groups as compared to the comparison groups [ 3 ] . Functional decline in this study was defined as a five-point or more decrease on the disability scale , institutionalization or death . This indicator has been used previously in other studies [ 4 , 5 ] . Moreover , participants with unmet needs , i.e. presenting disabilities not addressed by adequate re sources or services , were 31.4 % lower in the experimental groups in the fourth year of the study ( p<0.001 ) . These results are very conclusive since it was a population -based study design ed to measure effectiveness not efficacy . The subjects were r and omly selected from people 75 years and older at risk of functional decline , who did not necessarily benefit from the tested integrated care model during the study period . In fact , only 18 % of the subjects were assessed and cared for by a case manager in the experimental groups during the study period The Functional Autonomy Measurement System ( SMAF ) is an instrument design ed to assess disabilities related to 29 functions with a four-point scale ( from 0 : independent to -3 : dependent ) . For epidemiological studies , a total score and five sub-scores can be obtained . A revised version was developed adding a -0.5 level to many items to indicate an activity accomplished independently but with difficulty . The objective of the study was to verify the test-retest and inter-rater reliability of the total score and sub-scores of the SMAF . Ninety subjects were r and omly recruited in nine different residential setting s ranging from home to long-term-care hospitals . Half of the subjects were assessed by the same nurse within a 2-week interval ( test-retest ) and the other half were assessed twice by two different nurses within the same interval ( inter-rater ) . Results show intra-class correlation coefficients ( ICC ) of 0.95 and 0.96 for the total scores on test-retest and inter-rater reliability , respectively . The ICC were over 0.74 for all sub-scores for both types of reliability . A small systematic bias was present for two SMAF subscores on the inter-rater reliability . The addition of a new level did not modify the reliability of the scale OBJECTIVES To evaluate the impact of a coordination-type integrated service delivery ( ISD ) model on health , satisfaction , empowerment , and services utilization of frail older people . METHODS Program of Research to Integrate Services for the Maintenance of Autonomy ( PRISMA ) is a population -based , quasi-experimental study with three experimental and three comparison areas . From a r and om selection of people 75 years or older , 1,501 persons identified at risk of functional decline were recruited ( 728 experimental and 773 comparison ) . Participants were measured over 4 years for disabilities ( Functional Autonomy Measurement System ) , unmet needs , satisfaction with services , and empowerment . Information on utilization of health and social services was collected by bimonthly telephone question naires . RESULTS Over the last 2 years ( when the implementation rate was over 70 % ) , there were 62 fewer cases of functional decline per 1,000 individuals in the experimental group . In the fourth year of the study , the annual incidence of functional decline was lower by 137 cases per 1,000 in the experimental group , whereas the prevalence of unmet needs in the comparison region was nearly double the prevalence observed in the experimental region . Satisfaction and empowerment were significantly higher in the experimental group . For health services utilization , a lower number of visits to emergency rooms and hospitalizations than expected was observed in the experimental cohort . CONCLUSION The PRISMA model improves the efficacy of the health care system for frail older people 
    Output:
    
Literature analysis revealed the structures , processes and outcomes which underpinned the implementation .
The research also demonstrated benefits to the health system , including a more appropriate use of emergency rooms , and decreased consultations with medical specialists .
PRISMA provides evidence of the benefits that can arise from integrating care for older persons , particularly in terms of increased feelings of personal empowerment , and improved client satisfaction with the care provided .
Taken alongside other integrated care experiments , PRISMA provides further evidentiary support to policy-makers pursuing integrated care programs .