***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 : The hospital readmission rate has been proposed as an important outcome indicator computable from routine statistics . However , most commonly used measures raise conceptual issues . Objectives : We sought to evaluate the usefulness of the computerized algorithm for identifying avoidable readmissions on the basis of minimum bias , criterion validity , and measurement precision . Research Design and Subjects : A total of 131,809 hospitalizations of patients discharged alive from 49 hospitals were used to compare the predictive performance of risk adjustment methods . A subset of a r and om sample of 570 medical records of discharge/readmission pairs in 12 hospitals were review ed to estimate the predictive value of the screening of potentially avoidable readmissions . Measures : Potentially avoidable readmissions , defined as readmissions related to a condition of the previous hospitalization and not expected as part of a program of care and occurring within 30 days after the previous discharge , were identified by a computerized algorithm . Unavoidable readmissions were considered as censored events . Results : A total of 5.2 % of hospitalizations were followed by a potentially avoidable readmission , 17 % of them in a different hospital . The predictive value of the screen was 78 % ; 27 % of screened readmissions were judged clearly avoidable . The correlation between the hospital rate of clearly avoidable readmission and all readmissions rate , potentially avoidable readmissions rate or the ratio of observed to expected readmissions were respectively 0.42 , 0.56 and 0.66 . Adjustment models using clinical information performed better . Conclusion : Adjusted rates of potentially avoidable readmissions are scientifically sound enough to warrant their inclusion in hospital quality surveillance BACKGROUND the usefulness of geriatric evaluation and management ( GEM ) approaches in the care of frail elderly patients remains uncertain . We examined whether an inpatient geriatric consultation service might be beneficial in a country with a social welfare system . METHODS we conducted a r and omised trial with 345 patients from five centres . Ninety additional patients from four separate centres without GEM teams served as an external comparison . All patients were hospitalised , at least 65 years and frail . Patients were r and omly assigned to either comprehensive geriatric assessment and management in the form of consultations and follow-up or usual care . Primary outcomes were rehospitalisation and nursing home placement 1 year after r and omisation . Secondary outcomes were survival , functional , emotional and cognitive status , social situation and quality of life . FINDINGS at 12 months , the groups did not differ in the rate of rehospitalisation ( intervention 67 % , control 60 % , P=0.30 ) , nursing home placement ( intervention 19 % , control 14 % , P=0.27 ) , survival ( intervention 81 % , control 85 % , P=0.56 ) or any of the other secondary measures . The external comparison groups were also similar in nursing home placement ( 16 % , P=0.40 ) , survival ( 80 % , P=0.88 ) and all the secondary variables , but rehospitalisation was less ( 48 % , P=0.04 ) . No subgroup benefited from the intervention . INTERPRETATION care provided by consultation teams did not improve the rates of rehospitalisation or nursing home placement . This is not due to carry-over effects of geriatric knowledge into the control group Research is needed to help identify interventions that will improve the capacity or functioning of health systems and thereby contribute to achieving global health goals . Well conducted , r and omized controlled trials ( RCTs ) , insofar as they reduce bias and confounding , provide the strongest evidence for identifying which interventions delivered directly to individuals are safe and effective . When ethically feasible , they can also help reduce bias and confounding when assessing interventions targeting entire health systems . However , additional challenges emerge when research focuses on interventions that target the multiple units of organization found within health systems . Hence , one can not complacently assume that r and omization can reduce or eliminate bias and confounding to the same degree in every instance . While others have articulated arguments in favour of alternative design s , this paper is intended to help people underst and why the potential value afforded by RCTs may be threatened . Specifically , it suggests six points to be borne in mind when exploring the challenges entailed in design ing or evaluating RCTs on health system interventions : ( i ) the number of units available for r and omization ; ( ii ) the complexity of the organizational unit under study ; ( iii ) the complexity of the intervention ; ( iv ) the complexity of the cause-effect pathway , ( v ) contamination ; and ( vi ) outcome heterogeneity . The authors suggest that the latter may be informative and that the reasons behind it should be explored and not ignored . Based on improved underst and ing of the value and possible limitations of RCTs on health system interventions , the authors show why we need broader platforms of research to complement RCTs OBJECTIVES To evaluate an interdisciplinary intervention program for older people with hip fracture in Taiwan . DESIGN R and omized experimental design . SETTING A 3,800-bed medical center in northern Taiwan . PARTICIPANTS Elderly patients with hip fracture ( N=137 ) were r and omly assigned to an experimental ( n=68 ) or control ( n=69 ) group . INTERVENTION An interdisciplinary program of geriatric consultation , continuous rehabilitation , and discharge planning . MEASUREMENTS Demographic and outcome variables were measured . Outcome variables included service utilization , clinical outcomes , self-care abilities , health-related quality -of-life ( HRQOL ) outcomes , and depressive symptoms . RESULTS Subjects in the experimental group improved significantly more than those in the control group in the following outcomes : ratio of hip flexion 1 month after discharge ( P=.02 ) , recovery of previous walking ability at 1 month ( P=.04 ) and 3 months ( P=.001 ) after discharge , and activities of daily living at 1 month ( P=.01 ) and 2 months ( P=.001 ) after discharge . Three months after discharge , the experimental group showed significant improvement in peak force of the fractured limb 's quadriceps ( P=.04 ) and the following health outcomes : bodily pain ( P=.03 ) , vitality ( P<.001 ) , mental health ( P=.02 ) , physical function ( P<.001 ) , and role physical ( P=.006 ) . They also had fewer depressive symptoms ( P=.008 ) 3 months after discharge . CONCLUSION This intervention program may benefit older people with hip fractures in Taiwan by improving their clinical outcomes , self-care abilities , and HRQOL and by decreasing depressive symptoms within 3 months after discharge OBJECTIVE To test the impact of a geriatric evaluation and management model on the costs of acute hospital management of emergently admitted older adults . DESIGN R and omized controlled trial . Patients were followed in the acute hospital from admission through discharge . Results based on both univariate and multiple regression analyses . SETTING Private , nonprofit , academic medical center in a densely populated urban area . PATIENTS Adults 70 years of age and older admitted from the Emergency Department to the medicine service ( non-ICU admission ) who did not have an internist on staff at the admitting hospital . Of 141 r and omized patients , 111 ( 78.7 % ) met eligibility criteria . INTERVENTION Assignment of a geriatrician and a social worker as the primary managing team during the hospital stay . MAIN OUTCOME MEASURES Length of stay , total cost of acute hospital care , cost of laboratory , pharmacy , and rehabilitation services . RESULTS Patients in the intervention group had 2.1 fewer days of hospitalization , but this shorter length of stay was not statistically significant ( P = 0.108 ) . There were no differences in mortality or discharge disposition . In risk-adjusted , multiple regression analysis the intervention group had a statistically significant lower predicted total cost per patient than the usual care group ( -$2,544 , P = 0.029 ) ; assignment to the intervention group was associated with a lower predicted cost per patient for laboratory ( including cardiology graphics ) services ( P = 0.007 ) and pharmacy costs ( P = 0.047 ) . CONCLUSIONS When controlled for important predictors of expected re source use , care provided by a geriatric management team result ed in a significant reduction in the cost of hospitalization . A reduction in the cost of laboratory , cardiographic , and pharmacy services is consistent with the team 's philosophy of defining the services needed based on goals related to functional outcomes OBJECTIVES To develop a self-report screening tool to identify older people in the emergency department ( ED ) of a hospital at increased risk of adverse health outcomes  , including : death , admission to a nursing home or long-term hospitalization , or a clinical ly significant decrease in functional status .  DESIGN Prospect i ve ( 6-month ) follow-up study of a cohort of ED patients aged 65 and older . SETTING The EDs of four acute-care hospitals in Montreal , Quebec , Canada . PARTICIPANTS Community-dwelling patients aged 65 and older who came to the EDs during the weekday shift over a 3-month recruitment period . Patients were excluded if they could not be interviewed either because of their medical condition or because of cognitive impairment and no other informant was available . MEASUREMENTS Measures ascertained at the ED visit included : 27 self-report screening questions on social , physical , and mental risk factors ; medical history ; use of hospital services , medications , and alcohol ; and the Older American Re sources and Services ( OARS ) activities of daily living ( ADL ) scale . At follow-up , the OARS scale was readministered by telephone , and other adverse health outcomes were ascertained . RESULTS Among 1673 patients who completed the follow-up measures , 488 ( 29.2 % ) had an adverse health outcome . Scale development and selection methods included logistic regression , receiver operating characteristic curves , and expert judgment . The proposed screening tool ( ISAR ) comprises six self-report questions on functional dependence ( premorbid and acute change ) , recent hospitalization , impaired memory and vision , and polymedication . The tool performed well in the total cohort aged 65 and older , and in sub-groups defined by disposition ( admitted or released from ED ) , language of question naire administration ( French or English ) , information source ( patient or other ) , and other characteristics . CONCLUSIONS The ISAR is a short self-report question naire that can quickly identify older patients in the ED at increased risk of several adverse health outcomes and those with current disability OBJECTIVES To evaluate whether an early multidisciplinary geriatric intervention in elderly patients with hip fracture reduced length of stay , morbidity , and mortality and improved functional evolution . DESIGN R and omized , controlled intervention trial . SETTING Orthopedic ward in a university hospital . PARTICIPANTS Three hundred nineteen patients aged 65 and older hospitalized for hip fracture surgery . INTERVENTION Participants were r and omly assigned to a daily multidisciplinary geriatric intervention ( n=155 ) or usual care ( n=164 ) during hospitalization in the acute phase of hip fracture . MEASUREMENTS Primary endpoints were in-hospital length of stay and incidence of death or major medical complications . Secondary endpoints were the rate of recovery of previous activities of daily living and ambulation ability at 3 , 6 , and 12 months . RESULTS Median length of stay was 16 days in the geriatric intervention group and 18 days in the usual care group ( P=.06 ) . Patients assigned to the geriatric intervention showed a lower in-hospital mortality ( 0.6 % vs 5.8 % , P=.03 ) and major medical complications rate ( 45.2 % vs 61.7 % , P=.003 ) . After adjustment for confounding variables , geriatric intervention was associated with a 45 % lower probability of death or major complications ( 95 % confidence interval=7 - 68 % ) . More patients in the geriatric intervention group achieved a partial recovery at 3 months ( 57 % vs 44 % , P=.03 ) , but there were no differences between the groups at 6 and 12 months . CONCLUSION Early multidisciplinary daily geriatric care reduces in-hospital mortality and medical complications in elderly patients with hip fracture , but there is not a significant effect on length of hospital stay or long-term functional recovery Background and aims : Older hospitalized patients are at risk of functional decline , which is associated with several negative outcomes . The aim of this study was to compare the predictive accuracy of the Identification of Seniors At Risk ( ISAR ) , Variable Indicative for Placement risk ( VIP ) and the Flemish version of the Triage Risk Screening Tool ( TRST ) in predicting functional decline . Methods : A prospect i ve cohort study with 30 days follow-up in geriatric , medical and surgical wards in 25 hospitals was conducted . 752 participants aged 75 years or older were eligible for inclusion . Baseline data were gathered within 72 hours of admission . Functional decline was defined as an increase of one point or more from the premorbid Katz score to the score 30 days post-discharge . Positive predictive value ( PPV ) and negative predictive value ( NPV ) were calculated on 2 × 2 tables as well as by Bayes ’ theorem . Results : Functional decline at 30 days postdischarge was observed in 279 participants ( 39 % ) . ISAR and Flemish TRST showed high sensitivity ( 88%–78 % ) and fair NPV ( 62%–67 % ) , but low specificity ( 19%–30 % ) and low PPV ( 47%–48 % ) using the original cut-off of ≥2 . The sensitivity of VIP with cut-off ≥2 was too low ( 62 % ) , but could be optimized with cut-off ≥1 , showing sensitivity , specificity , PPV and NPV of 8 
    Output:
    
Results The individual studies show that an inpatient geriatric consultation team intervention has favorable effects on functional status , readmission and mortality rate .
None of the studies found an effect on the length of the hospital stay .
Conclusions Inpatient geriatric consultation team interventions have a significant impact on mortality rate at 6 and 8 months postdischarge , but have no significant impact on functional status , readmission or length of stay .
The reason for the lack of effect on these latter outcomes may be due to insufficient statistical power or the insensitivity of the measuring method for , for example , functional status .