***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: BACKGROUND Case management is believed to promote continuity of care and decrease hospitalization rates , although few controlled trials have tested this approach . OBJECTIVE To assess the effectiveness of a st and ardized telephonic case-management intervention in decreasing re source use in patients with chronic heart failure . METHODS A r and omized controlled clinical trial was used to assess the effect of telephonic case management on re source use .  Patients were identified at hospitalization and assigned to receive 6 months of intervention ( n = 130 ) or usual care ( n = 228 ) based on the group to which their physician was r and omized .  Hospitalization rates , readmission rates , hospital days , days to first rehospitalization , multiple readmissions , emergency department visits , inpatient costs , outpatient re source use , and patient satisfaction were measured at 3 and 6 months . RESULTS The heart failure hospitalization rate was 45.7 % lower in the intervention group at 3 months ( P = .03 ) and 47.8 % lower at 6 months ( P = .01 ) . Heart failure hospital days ( P = .03 ) and multiple readmissions ( P = .03 ) were significantly lower in the intervention group at 6 months . Inpatient heart failure costs were 45.5 % lower at 6 months ( P = .04 ) . A cost saving was realized even after intervention costs were deducted . There was no evidence of cost shifting to the outpatient setting . Patient satisfaction with care was higher in the intervention group . CONCLUSIONS The reduction in hospitalizations , costs , and other re source use achieved using st and ardized telephonic case management in the early months after a heart failure admission is greater than that usually achieved with pharmaceutical therapy and comparable with other disease management approaches Background : There is still debate over the benefit of self-management programmes for adults with asthma . A brief self-management programme given during a hospital admission for acute asthma was tested to determine whether it would reduce readmission . Method : A r and omised controlled trial was performed in 280 adult patients with acute asthma admitted over 29 months . Patients on the self-management programme ( SMP ) received 40–60 minutes of education supporting a written self-management plan . Control patients received st and ard care ( SC ) . Results : One month after discharge SMP patients were more likely than SC patients to report no daytime wheeze ( OR 2.6 , 95 % CI 1.5 to 5.3 ) , no night disturbance ( OR 2.0 , 95 % CI 1.2 to 3.5 ) , and no activity limitation ( OR 1.5 , 95 % CI 0.9 to 2.7 ) . Over 12 months 17 % of SMP patients were re-admitted compared with 27 % of SC patients ( OR 0.5 , 95 % CI 0.3 to 1.0 ) . Among first admission patients , OR readmission ( SMP v SC ) was 0.2 ( 95 % CI 0.1 to 0.7 ) , p<0.01 . For patients with a previous admission , OR readmission was 0.8 ( 95 % CI 0.4 to 1.6 ) , p=0.6 . SMP patients were more likely than SC patients to be prescribed inhaled steroids at discharge ( 99 % v 92 % , p=0.03 ) , oral steroids ( 98 % v 90 % , p=0.06 ) , and to have hospital follow up ( 98 % v 84 % , p<0.01 ) but adjustment for these differences did not diminish the effect of the self-management programme . Conclusions : A brief self-management programme during hospital admission reduced post discharge morbidity and readmission for adult asthma patients . The benefit of the programme may have been greater for patients admitted for the first time . The programme also had a small but significant effect on medical management at discharge OBJECTIVES to investigate the effectiveness of a  pharmacy discharge plan  in elderly hospitalized patients . DESIGN r and omized controlled trial . SUBJECTS AND SETTING S we r and omized patients aged 75 years and older on four or more medicines who had been discharged from three acute general and one long-stay hospital to a pharmacy intervention or usual care . INTERVENTIONS the hospital pharmacist developed discharge plans which gave details of medication and support required by the patient . A copy was given to the patient and to all relevant professionals and carers . This was followed by a domiciliary assessment by a community pharmacist . In the control group , patients were discharged from hospital following st and ard procedures that included a discharge letter to the general practitioner listing current medications . OUTCOMES the primary outcome was re-admission to hospital within 6 months . Secondary outcomes included the number of deaths , attendance at hospital outpatient clinics and general practice and proportion of days in hospital over the follow-up period , together with patients ' general well-being , satisfaction with the service and knowledge of and adherence to prescribed medication . RESULTS we recruited 362 patients , of whom 181 were r and omized to each group . We collected hospital and general practice data on at least 91 and 72 % of patients respectively at each follow-up point and interviewed between 43 and 90 % of the study subjects . There were no significant differences between the groups in the proportion of patients re-admitted to hospital between baseline and 3 months or 3 and 6 months . There were no significant differences in any of the secondary outcomes . CONCLUSIONS we found no evidence to suggest that the co-ordinated hospital and community pharmacy care discharge plans in elderly patients in this study influence outcomes Background Pre-discharge home visits aim to maximise independence in the community . These visits involve assessment of a person in their own home prior to discharge from hospital , typically by an occupational therapist . The therapist may provide equipment , adapt the home environment and /or provide education . The aims of this study were to investigate the feasibility of a r and omised controlled trial in a clinical setting and the effect of pre-discharge home visits on functional performance in older people undergoing rehabilitation . Methods Ten patients participating in an inpatient rehabilitation program were r and omly assigned to receive either a pre-discharge home visit ( intervention ) , or st and ard practice in-hospital assessment and education ( control ) , both conducted by an occupational therapist . The pre-discharge home visit involved assessment of the older person 's function and environment , and education , and took an average of 1.5 hours . The hospital-based interview took an average of 40 minutes . Outcome data were collected by a blinded assessor at 0 , 2 , 4 , 8 and 12 weeks . Outcomes included performance of activities of daily living , reintegration to community living , quality of life , readmission and fall rates . Results Recruitment of 10 participants was slow and took three months . Observed performance of functional abilities did not differ between groups due to the small sample size . Difference in activities of daily living participation , as recorded by the Nottingham Extended Activities of Daily Living scale , was statistically significant but wide confidence intervals and low statistical power limit interpretation of results . Conclusion Evaluation of pre-discharge home visits by occupational therapists in a rehabilitation setting is feasible , but a more effective recruitment strategy for a main study is favored by application of a multi-centre setting AIMS To test the effect of education and support by a nurse on self-care and re source utilization in patients with heart failure . METHODS A total of 179 patients ( mean age 73 , 58 % male , NYHA III-IV ) hospitalized with heart failure were evaluated prospect ively . Patients were r and omized to the study intervention or to ' care as usual '  . The supportive educative intervention consisted of intensive , systematic and planned education by a study nurse about the consequences of heart failure in daily life , using a st and ard nursing care plan developed by the research ers for older patients with heart failure . Education and support took place during the hospital stay and at a home visit within a week of discharge . Data were collected on self-care abilities , self-care behaviour , readmissions , visits to the emergency heart centre and use of other health care re sources . RESULTS Education and support from a nurse in a hospital setting and at home significantly increases self-care behaviour in patients with heart failure . Patients from both the intervention and the control group increased their self-care behaviour within 1 month of discharge , but the increase in the intervention group was significantly more after 1 month . Although self-care behaviour in both groups decreased during the following 8 months , the increase from baseline remained statistically significant in the intervention group , but not in the control group . No significant effects on re source utilization were found . CONCLUSIONS Intensive , systematic , tailored and planned education and support by a nurse results in an increase in patients ' self-care behaviour . No significant effects were found on use of health care re sources . Additional organisational changes , such as longer follow-up and the availability of a heart failure specialist would probably enhance the effects of education and support To select patients for early discharge planning , a r and omized clinical trial evaluated a protocol that used risk factors identified upon hospital admission . The goal of the study was to determine if intervention with high-risk patients could reduce the need for hospital admission or skilled care .  Of 13,255 patients screened , 835 study participants were identified as " at risk " for frequent health care re source use . Half of the high-risk patients were r and omly assigned to the experimental group ( n=417 ) and received discharge planning from day 3 of their hospital stay , while the control group ( n=418 ) received discharge planning only if there was a written physician request . Those patients receiving early , systematic discharge planning experienced an increased likelihood of successful return to home after hospital admission and a decreased chance of unscheduled readmission for the 9-month study period . Length of the index hospital stay was not affected by early planning , however . The major clinical implication is the potential for discharge planners to decrease the need for , and use of , health care re sources after hospital admission Background  Readmission rates for patients with heart failure are a major concern for hospitals worldwide . The importance of patient education and a structured care plan to ease the transition from hospital to home has been the focus of many intervention strategies to reduce readmission rates . The use of transitioning of care plans is believed to improve medication reconciliation , communication , patient education , and follow‐up . To date , the evidence has not been systematic ally evaluated to support the effectiveness of a nurse coordinated transitioning of care for patients with heart failure in reducing readmission rates . Objective The objective of the systematic review was to identify the best available evidence on the effectiveness of nurse coordinated transitioning of care between hospital and home on hospital readmission rates for all causes in adult patients hospitalised with heart failure . Search strategy The search strategy aim ed to find both published and unpublished studies in the English language from January 1975 through July 2010 . A search of MEDLINE , CINAHL , PsycINFO , Health source Nursing/academic edition , EMBASE , the Cochrane Library , and the Joanna Briggs Institute Library of Systematic Review s was conducted followed by a reference search of relevant studies . The initial key words search ed were : heart failure , readmission , and transitional care . Inclusion criteria R and omised controlled trials that evaluated the effect of nurse coordinated transitioning of care from hospital to home in adult patients with heart failure on  readmission  rates were selected . The outcome was defined as hospital readmissions for all causes following an initial admission for heart failure . Data collection and analysis Studies selected for retrieval were critically evaluated by two independent review ers for method ological validity using st and ardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument ( JBI‐MAStARI ) . Data were extracted and analysed using the JBI‐MAStARI program . Results A total of 16 r and omised controlled studies were included . Ten of the 16 studies included in the review show that a nurse led transitioning of care intervention can reduce the rate of readmission for patients with heart failure . Interventions utilising home visits , or home visits coupled with telephone follow‐up , show a more favourable reduction in readmission rates . Conclusions Reduced readmissions occur when transitioning of care interventions are carried out by a heart failure trained nurse who conducts at least one home visit and follows the patient at least weekly for a minimum of 30 days post discharge with either additional home visits or telephone contact . Implication s for practice This review supports the development of a nurse coordinated transitioning of care plan which will require improvements in communication , in addition to changes in health policy and payment systems that align incentives and performance measures in caring for patients with heart failure . Implication s for research Future research should evaluate the effect of the intensity and duration of the transitioning of care intervention on readmission rates in a large r and omised control trial on an adult population with heart failure to determine the ideal frequency and duration of the post discharge interventions Background Hospital readmission soon after discharge is common and costly . To date , published studies of effectiveness of structured discharge process addressing reduction of hospital readmission have focused on patients with chronic conditions and complex needs , but not in adult patients with community acquired pneumonia . Objectives To examine and synthesis e the best available evidence related to effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia . Inclusion criteria Types of participants This review considered studies that included hospitalised adult patients diagnosed with community acquired pneumonia regardless of gender , ethnicity , severity , and co‐morbidities . Types of interventions Structured discharge process related to early patient engagement , patient‐caregiver dyad intervention , transitional care , coordinated care , and multidisciplinary team approach . Types of outcome measures The outcome measures included in this review were hospital readmission , emergency room visits , and unscheduled visits to healthcare provider . Types of Studies R and omised controlled trials ( RCTs ) and quasi‐experimental studies were considered for inclusion . Search strategy The search strategy aim ed to find both published and unpublished studies in English language without date limits . A search of PubMed / MEDLINE , CINAHL , CINAHL Plus , EMBASE , Cochrane Central Register of Controlled Trials ( CENTRAL ) , PsycINFO , Academic Search Premier , Health Source Nursing/Academic Edition and seven other data bases was conducted . Method o 
    Output:
    
Interventions design ed to improve the care transition from hospital to home are effective in reducing  hospital readmission .
These interventions preferably start in the hospital and continue after discharge rather than starting after discharge .
Enhancing patient empowerment is a key factor in reducing hospital readmissions .
Interventions that support patient empowerment are more effective in reducing hospital readmissions ( grade B recommendation ) .