***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: Abstract Objectives : To examine the cost of providing hospital at home in place of some forms of inpatient hospital care . Design : Cost minimisation study within a r and omised controlled trial . Setting : District general hospital and catchment area of neighbouring community trust . Subjects : Patients recovering from hip replacement ( n=86 ) , knee replacement ( n=86 ) , and hysterectomy ( n=238 ) ; elderly medical patients ( n=96 ) ; and patients with chronic obstructive airways disease ( n=32 ) . Interventions : Hospital at home or inpatient hospital care . Main outcome measures : Cost of  hospital at home scheme to health service , to general practitioners , and to patients and their families compared with hospital care . Results : No difference was detected in total healthcare costs between hospital at home and hospital care for patients recovering from a hip or knee replacement , or elderly medical patients .  Hospital at home significantly increased healthcare costs for patients recovering from a hysterectomy ( ratio of geometrical means 1.15 , 95 % confidence interval 1.04 to 1.29 , P=0.009 ) and for those with chronic obstructive airways disease ( Mann-Whitney U test , P=0.01 ) . Hospital at home significantly increased general practitioners ' costs for elderly medical patients ( Mann-Whitney U test , P<0.01 ) and for those with chronic obstructive airways disease ( P=0.02 ) . Patient and carer expenditure made up a small proportion of total costs . Conclusion : Hospital at home care did not reduce total healthcare costs for the conditions studied in this trial , and costs were significantly increased for patients recovering from a hysterectomy and those with chronic obstructive airways disease . There was some evidence that costs were shifted to primary care for elderly medical patients and those with chronic obstructive airways disease . Key messages Hospital at home schemes are a popular alternative to st and ard hospital care , but there is uncertainty about their cost effectiveness In our r and omised controlled trial we compared the cost of hospital at home care with that of inpatient hospital care for patients recovering from hip replacement , knee replacement , and hysterectomy ; elderly medical patients ; and those with chronic obstructive airways disease There were no major differences in health service costs between the two arms of the trial for patients recovering from hip or knee replacement and elderly medical patients Hospital at home care increased healthcare costs for patients recovering from hysterectomy and for those with chronic obstructive airways disease Hospital at home care result ed in some costs shifting to general practitioners for elderly medical patients and those with chronic obstructive airways BACKGROUND Comprehensive geriatric assessment ( CGA ) can be effective in inpatient units , but such inpatient setting s are prohibitively expensive . If similar benefits could be obtained in outpatient setting s , CGA might be a more attractive option . OBJECTIVES To assess the cost-effectiveness ( CE ) of an outpatient geriatric assessment with an intervention to increase adherence . SUBJECTS Three hundred fifty-one community-dwelling , elderly subjects with at least one of four geriatric conditions . MEASURES In addition to the measures of functioning , we collected data on the costs of the intervention itself and on the use of medical services in the 64 weeks after the intervention . RESULTS The intervention , which prevented functional decline , cost $ 273 per participant . The intervention group averaged three more visits than the control group in the first 32 weeks after the intervention , but only 1.2 extra visits in the next 32 weeks . We estimate that the costs of these additional medical services would be $ 473 for the 5 years after the intervention , leading to a total cost per Quality Adjusted Life Year ( QALY ) of $ 10,600 . CONCLUSIONS The CE of this program compares favorably with many common medical interventions . Whether investments should be made in health care re sources on treatments that lead to modest improvements in the functioning of community-dwelling elderly people remains a societal decision The purpose of this study was to evaluate high-risk older adults ' satisfaction with outpatient  geriatric evaluation and management ( GEM ) .  Community-dwelling Medicare beneficiaries ( n = 522 ) age 70 years and older who had a high probability of repeated admission to hospitals ( Pra > .40 ) were r and omly assigned to receive either  usual care or GEM  for six months . Despite the stresses imposed by outpatient GEM ( e.g. , new relationships with providers , frequent office visits and changes in treatments ) , the mean satisfaction scores of the recipients of GEM were 9 % higher than those of the recipients of usual care ( 4.31 vs 3.96 , p < .001 ) . The primary physicians of GEM recipients were also highly satisfied with GEM care CONTEXT Low-income seniors frequently have multiple chronic medical conditions for which they often fail to receive the recommended st and ard of care . OBJECTIVES To test the effectiveness of a geriatric care management model on improving the quality of care for low-income seniors in primary care . DESIGN , SETTING , AND PATIENTS Controlled clinical trial of 951 adults 65 years or older with an annual income less than 200 % of the federal poverty level , whose primary care physicians were r and omized from January 2002 through August 2004 to participate in the intervention ( 474 patients ) or usual care ( 477 patients ) in community-based health centers . INTERVENTION Patients received 2 years of home-based care management by a nurse practitioner and social worker who collaborated with the primary care physician and a geriatrics interdisciplinary team and were guided by 12 care protocol s for common geriatric conditions . MAIN OUTCOME MEASURES The Medical Outcomes 36-Item Short-Form ( SF-36 ) scales and summary measures ; instrumental and basic activities of daily living ( ADLs ) ; and emergency department ( ED ) visits not result ing in hospitalization and hospitalizations . RESULTS Intention-to-treat analysis revealed significant improvements for intervention patients compared with usual care at 24 months in 4 of 8 SF-36 scales : general health ( 0.2 vs -2.3 , P = .045 ) , vitality ( 2.6 vs -2.6 , P < .001 ) , social functioning ( 3.0 vs -2.3 , P = .008 ) , and mental health ( 3.6 vs -0.3 , P = .001 ) ; and in the Mental Component Summary ( 2.1 vs -0.3 , P < .001 ) . No group differences were found for ADLs or death . The cumulative 2-year ED visit rate per 1000 was lower in the intervention group ( 1445 [ n = 474 ] vs 1748 [ n = 477 ] , P = .03 ) but hospital admission rates per 1000 were not significantly different between groups ( 700 [ n = 474 ] vs 740 [ n = 477 ] , P = .66 ) . In a predefined group at high risk of hospitalization ( comprising 112 intervention and 114 usual-care patients ) , ED visit and hospital admission rates were lower for intervention patients in the second year ( 848 [ n = 106 ] vs 1314 [ n = 105 ] ; P = .03 and 396 [ n = 106 ] vs 705 [ n = 105 ] ; P = .03 , respectively ) . CONCLUSIONS Integrated and home-based geriatric care management result ed in improved quality of care and reduced acute care utilization among a high-risk group . Improvements in health-related quality of life were mixed and physical function outcomes did not differ between groups . Future studies are needed to determine whether more specific targeting will improve the program 's effectiveness and whether reductions in acute care utilization will offset program costs . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00182962 CONTEXT Although home-based health care has grown over the past decade , its effectiveness remains controversial . A prior trial of Veterans Affairs ( VA ) Team-Managed Home-Based Primary Care ( TM/HBPC ) found favorable outcomes , but the replicability of the model and generalizability of the findings are unknown . OBJECTIVES To assess the impact of TM/HBPC on functional status , health-related quality of life ( HR-QoL ) , satisfaction with care , and cost of care . DESIGN AND SETTING Multisite r and omized controlled trial conducted from October 1994 to September 1998 in 16 VA medical centers with HBPC programs . PARTICIPANTS A total of 1966 patients with a mean age of 70 years who had 2 or more activities of daily living impairments or a terminal illness , congestive heart failure ( CHF ) , or chronic obstructive pulmonary disease ( COPD ) .  Intervention Home-based primary care ( n=981 ) , including a primary care manager , 24-hour contact for patients , prior approval of hospital readmissions , and HBPC team participation in discharge planning , vs customary VA and private sector care ( n=985 ) . MAIN OUTCOME MEASURES Patient functional status , patient and caregiver HR-QoL and satisfaction , caregiver burden , hospital readmissions , and costs over 12 months . RESULTS Functional status as assessed by the Barthel Index did not differ for terminal ( P=.40 ) or nonterminal ( those with severe disability or who had CHF or COPD ) ( P=.17 ) patients by treatment group . Significant improvements were seen in terminal TM/HBPC patients in HR-QoL scales of emotional role function , social function , bodily pain , mental health , vitality , and general health . Team-Managed HBPC nonterminal patients had significant increases of 5 to 10 points in 5 of 6 satisfaction with care scales . The caregivers of terminal patients in the TM/HBPC group improved significantly in HR-QoL measures except for vitality and general health . Caregivers of nonterminal patients improved significantly in QoL measures and reported reduced caregiver burden ( P=.008 ) . Team-Managed HBPC patients with severe disability experienced a 22 % relative decrease ( 0.7 readmissions/patient for TM/HBPC group vs 0.9 readmissions/patient for control group ) in hospital readmissions ( P=.03 ) at 6 months that was not sustained at 12 months . Total mean per person costs were 6.8 % higher in the TM/HBPC group at 6 months ( $ 19190 vs $ 17971 ) and 12.1 % higher at 12 months ( $ 31401 vs $ 28008 ) . CONCLUSIONS The TM/HBPC intervention improved most HR-QoL measures among terminally ill patients and satisfaction among non-terminally ill patients . It improved caregiver HR-QoL , satisfaction with care , and caregiver burden and reduced hospital readmissions at 6 months , but it did not substitute for other forms of care . The higher costs of TM/HBPC should be weighed against these benefits OBJECTIVE To compare GPs ' willingness to participate in a GP pre-discharge project as measured by a survey , with actual participation rates . To identify the characteristics of GPs likely to make a pre-discharge visit to frail , aged in patients admitted under the care of a geriatrician . METHOD PRE-IMPLEMENTATION GP SURVEY : Survey of a r and om sample of 100 GPs from the Central Sydney area using a st and ardised question naire .  PRE-DISCHARGE VISIT PROJECT : Information on actual participation rates and GPs who declined to make a pre-discharge visit was obtained from an audit of Division of General Practice records . Information on Patient characteristics was obtained from patient interviews and medical records . The survey was conducted at the Balmain Hospital and Concord Repatriation and General Hospitals located within the Central Sydney Area Health Service . The subjects were GPs practising in central Sydney and patients admitted under the care of a geriatrician at Balmain and Concord Hospitals . RESULTS Twenty-nine per cent of GPs reported that they were willing to undertake visits without remuneration and 71 % reported they were willing to make a pre-discharge visit if remunerated . Fifty-three per cent of GPs actually complied with a request to make a remunerated pre-discharge visit . This was 18 % less than the rate determined by the survey . GPs were less likely to make a visit if they were solo practitioners and not members of the Division . Patients who were more dependent , as measured by total Barthel 's score , and those from nursing homes were less likely to receive a visit . CONCLUSION GP surveys may overestimate participation rates in Division projects . In reality , it appears difficult for GPs to accommo date pre-discharge visits in a general practice routine and the offered remunerations may not be adequate compensation for time lost when undertaking a pre-discharge visit . Lastly , some GPs may not see a benefit in visiting more dependent patients In this ongoing r and omized controlled trial the effectiveness of an interdisciplinary team implementing hospital-based comprehensive geriatric assessment ( CGA ) and home intervention is being studied . All patients admitted from home showing functional decline with impairment of any basic activity of daily living are r and omly assigned to one of the following courses of treatment : CGA with in-hospital and post discharge management by a home intervention team ( HIT ) , where necessary ( group 1 ) : CGA with recommendations and usual care at home ( group 2 ) ; or usual hospital and home care ( group 3 ) . The HIT consists of 3 nurses , 1 geriatrician , 1 physiotherapist , 1 occupational therapist , and 1 social worker . 540 patients will be recruited for the trial , which will assess the effects of GEM-HIT on the following outcomes : health status , functional status , survival , hospital readmission , nursing 
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We retrieved 3211 records and included 37 RCTs which were mapped onto the IPW models : Overall , there is weak evidence of effectiveness and cost-effectiveness for IPW , although well-integrated and shared care models improved processes of care and have the potential to reduce hospital or nursing/care home use .