***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 
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    Input: Background Little is known about the factors associated with frequency of emergency department visits ( FEDV )  in chronic obstructive pulmonary disease ( COPD ) patients with recurrent exacerbations . Objective To characterize the use of emergency department ( ED ) services in patients with COPD exacerbation and identify factors associated with FEDV . Design A prospect i ve , multicenter cohort study . Patients Three hundred eighty-eight patients were included . Fifty-two percent were women and the median age was 69 years ( interquartile range 62–76 ) . Measurements Using a st and ard question naire , consecutive ED patients with COPD exacerbation were interviewed . The number of ED visits in the previous year was retrospectively collected . Results Over the past year , this cohort reported a total of 1,090 ED visits because of COPD exacerbation . Thirteen percent of COPD patients had 6 or more ED visits , accounting for 57 % of the total ED visits in the past year . Multivariate analysis showed that patients with an increased FEDV were more likely to be Hispanic ( incidence rate ratio [ IRR ] 1.97 , 95 % confidence interval [ CI ] 1.16–3.33 ) , to have more severe COPD as determined by previous hospitalizations ( IRR 2.06 , 95 % CI 1.51–2.82 ) , prior intubations ( IRR 1.49 , 95 % CI 1.02–2.18 ) , prior use of systemic corticosteroids ( IRR 1.57 , 95 % CI 1.16–2.13 ) and methylxanthine ( IRR 1.48 , 95 % CI 1.04–2.12 ) , and less likely to have a primary care provider ( IRR 0.51 , 95 % CI 0.31–0.82 ) . Conclusions Our results suggest that both disease and health care-related factors were associated with FEDV in COPD exacerbation . Multidisciplinary efforts through primary care provider follow-up should be assessed to test the effects on reducing the high morbidity and cost of recurrent COPD exacerbations Pulmonary rehabilitation is beneficial for patients with chronic lung disease . However , long-term maintenance has been difficult to achieve after short-term treatment . We evaluated a telephone-based maintenance program after pulmonary rehabilitation in 172 patients with chronic lung disease recruited from pulmonary rehabilitation graduates . Subjects were r and omly assigned to a 12-month maintenance intervention with weekly telephone contacts and monthly supervised reinforcement sessions ( n = 87 ) or st and ard care ( n = 85 ) and followed for 24 months . Except for a slight imbalance between sexes , experimental and control groups were equivalent at baseline and showed similar improvements after rehabilitation . During the 12-month intervention , exercise tolerance ( maximum treadmill workload and 6-minute walk distance ) and overall health status ratings were better maintained in the experimental group together with a reduction in hospital days . There were no group differences for other measures of pulmonary function , dyspnea , self-efficacy , generic and disease-specific quality of life , and health care use . By 24 months , there were no significant group differences . Patients returned to levels close to but above prerehabilitation measures . We conclude that a maintenance program of weekly telephone calls and monthly supervised sessions produced only modest improvements in the maintenance of benefits after pulmonary rehabilitation It was postulated that home hospitalisation ( HH ) of selected chronic obstructive pulmonary disease ( COPD ) exacerbations admitted at the emergency room ( ER ) could facilitate a better outcome than conventional hospitalisation . To this end , 222 COPD patients ( 3.2 % female ; 71±10 yrs ( mean±sd ) ) were r and omly assigned to HH ( n=121 ) or conventional care ( n=101 ) . During HH , integrated care was delivered by a specialised nurse with the patient 's free-phone access to the nurse ensured for an 8‐week follow-up period . Mortality ( HH : 4.1 % ; controls : 6.9 % ) and hospital readmissions ( HH : 0.24±0.57 ; controls : 0.38±0.70 ) were similar in both groups . However , at the end of the follow-up period , HH patients showed : 1 ) a lower rate of ER visits ( 0.13±0.43 versus 0.31±0.62 ) ; and 2 ) a noticeable improvement of quality of life ( Δ St George 's Respiratory Question naire ( SGRQ ) , −6.9 versus −2.4 ) . Furthermore , a higher percentage of patients had a better knowledge of the disease ( 58 % versus 27 % ) , a better self-management of their condition ( 81 % versus 48 % ) , and the patient 's satisfaction was greater . The average overall direct cost per HH patient was 62 % of the costs of conventional care , essentially due to fewer days of inpatient hospitalisation ( 1.7±2.3 versus 4.2±4.1 days ) . A comprehensive home care intervention in selected chronic obstructive pulmonary disease exacerbations appears as cost effective . The home hospitalisation intervention  generates better outcomes at lower costs than conventional care Background  Hospital readmission for acute exacerbation of COPD ( AE COPD ) occurs in up to 30 % of patients , leading to excess morbidity and poor survival . Physiological risk factors predict readmission , but the impact of modifiable psychosocial risk factors remains uncertain . We aim ed to evaluate whether psychosocial risk factors independently predict readmission for AE COPD in patients referred to early discharge services ( EDS ) . Methods This prospect i ve cohort study included 79 patients with AE COPD cared for by nurse led EDS in the UK , and followed up for 12 months . Data on lung function , medical comorbidities , previous hospital admissions , medications , and sociodemographics were collected at baseline ; St George 's Respiratory Question naire ( SGRQ ) , Hospital Anxiety and Depression Scale ( HADS ) , and social support were measured at baseline , 3 and 12-months . Exploratory multivariate models were fitted to identify psychosocial factors associated with readmission adjusted for known confounders . Results 26 patients were readmitted within 90 days and 60 patients were readmitted at least once during follow-up . Depression at baseline predicted readmission adjusted for sociodemographics and forced expiratory volume in 1 second ( odds ratio 1.30 , 95 % CI 1.06 to 1.60 , p = 0.013 ) . Perceived social support was not significantly associated with risk of readmission . Home ownership was associated with the total number of readmissions ( B = 0.46 , 95 % CI -0.86 to -0.06 , p = 0.024 ) . Compared with those not readmitted , readmitted patients had worse SGRQ and HADS scores at 12 months . Conclusion Depressive symptoms and socioeconomic status , but not perceived social support , predict risk of readmission and readmission frequency for AE COPD in patients cared for by nurse-led EDS . Future work on reducing dem and for unscheduled hospital admissions could include the design and evaluation of interventions aim ed at optimising the psychosocial care of AE COPD patients managed at home Objectives : To determine the effects of a nurse led intermediate care programme in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease ( AE COPD ) . Design : R and omised controlled trial . Setting : Community and hospital care in west London . Participants : 122 patients with COPD . Intervention : A care package incorporating initial pulmonary rehabilitation and self-management education , provision of a written , personalised COPD action plan , monthly telephone calls and 3 monthly home visits by a specialist nurse for a period of 2 years . Main outcome measure : Hospital readmission rate . Secondary outcomes : Unscheduled primary care consultations and quality of life . Results : There were no differences in hospital admission rates or in exacerbation rates between the two groups . Self-management of exacerbations was significantly different and the intervention group were more likely to be treated with oral steroids alone or oral steroids and antibiotics , and the initiators of treatment for exacerbations were statistically more likely to be the patients themselves . 12 patients in the control group died during the 2 year period , eight as a result of COPD , compared with six patients in the intervention group , of whom one died from COPD . This is a significant difference . When the numbers were adjusted to reflect the numbers still alive at 2 years , in the intervention group patients reported a total of 171 unscheduled contacts with their general practitioner ( GP ) and in the control group , 280 contacts . The number needed to treat was 0.558—ie , for every one COPD patient receiving the intervention and self-management advice , there were 1.79 fewer unscheduled contacts with the GP . Conclusions : An intermediate care package incorporating pulmonary rehabilitation , self-management education and the receipt of a written COPD action plan , together with regular nurse contact , is associated with a reduced need for unscheduled primary care consultations and a reduction in deaths due to COPD but did not affect the hospital readmission rate BACKGROUND Patients with depression and poorly controlled diabetes , coronary heart disease , or both have an increased risk of adverse outcomes and high health care costs . We conducted a study to determine whether coordinated care management of multiple conditions improves disease control in these patients . METHODS We conducted a single-blind , r and omized , controlled trial in 14 primary care clinics in an integrated health care system in Washington State , involving 214 participants with poorly controlled diabetes , coronary heart disease , or both and coexisting depression . Patients were r and omly assigned to the usual-care group or to the intervention group , in which a medically supervised nurse , working with each patient 's primary care physician , provided guideline -based , collaborative care management , with the goal of controlling risk factors associated with multiple diseases . The primary outcome was based on simultaneous modeling of glycated hemoglobin , low-density lipoprotein ( LDL ) cholesterol , and systolic blood-pressure levels and Symptom Checklist-20 ( SCL-20 ) depression outcomes at 12 months ; this modeling allowed estimation of a single overall treatment effect . RESULTS As compared with controls , patients in the intervention group had greater overall 12-month improvement across glycated hemoglobin levels ( difference , 0.58 % ) , LDL cholesterol levels ( difference , 6.9 mg per deciliter [ 0.2 mmol per liter ] ) , systolic blood pressure ( difference , 5.1 mm Hg ) , and SCL-20 depression scores ( difference , 0.40 points ) ( P<0.001 ) . Patients in the intervention group also were more likely to have one or more adjustments of insulin ( P=0.006 ) , antihypertensive medications ( P<0.001 ) , and antidepressant medications ( P<0.001 ) , and they had better quality of life ( P<0.001 ) and greater satisfaction with care for diabetes , coronary heart disease , or both ( P<0.001 ) and with care for depression ( P<0.001 ) . CONCLUSIONS As compared with usual care , an intervention involving nurses who provided guideline -based , patient-centered management of depression and chronic disease significantly improved control of medical disease and depression . ( Funded by the National Institute of Mental Health ; Clinical Trials.gov number , NCT00468676 . ) OBJECTIVE Patients with chronic obstructive pulmonary disease ( COPD ) and a history of frequent exacerbations are a target population of particular interest from both a clinical and an economic st and point . The objective of this study was to evaluate the effectiveness of a program design ed specifically to manage patients in this subgroup . PATIENTS AND METHODS This was a 1-year r and omized controlled trial design ed to compare the effectiveness of a specific program ( SP ) with that of conventional management ( CM ) in a group of patients with a high frequency of exacerbations ( 3 or more per year ) . Within-group and between-group comparisons were carried out for a number of variables related to the patients medical care , dyspnea , health-related quality of life ( HRQL ) , inhalation technique , and pulmonary function . RESULTS A total of 26 patients were enrolled in the study ( all men ) . The mean ( SD ) age was 73 ( 8) years , and mean forced expiratory volume in 1 second ( FEV1 ) expressed as a percentage of the reference value was 43 % ( 15 % ) .  Exacerbations requiring hospital care ( emergency department visits and /or admission ) decreased in both groups : by 24.4 % ( P not significant ) in the CM group and 44.1 % ( P=.061 ) in the SP group . Hospital admissions decreased 73.3 % in the SP group and increased 22 % in the CM group ( P < .001 ) . While length of hospital stay decreased 77.3 % in the SP group , this figure almost doubled in the CM group ( P=.014 ) . Dyspnea , HRQL , and inhalation technique improved in both groups . FEV1 fell by 46 mL/year in the CM group and increased 10 mL/year in the SP group ( P not significant ) . CONCLUSIONS The use of a simple program to manage selected patients with a history of frequent exacerbations produces a significant reduction in the number of hospital admissions , an improvement in HRQL , and may improve prognosis OBJECTIVE To determine the long-term effects on total healthcare costs of the Improving Mood : Promoting Access to Collaborative Treatment ( IMPACT ) program for late-life de 
    Output:
    
Use of urgent healthcare in patients with COPD was significantly reduced by complex interventions .