***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 : Urgent , unplanned hospital readmissions are increasingly being used to gauge the quality of care . We review ed urgent readmissions to determine which were potentially avoidable and compared rates of all-cause and avoidable readmissions . Methods : In a multicentre , prospect i ve cohort study , we review ed all urgent readmissions that occurred within six months among patients discharged to the community from 11 teaching and community hospitals between October 2002 and July 2006 . Summaries of the readmissions were review ed by at least four practising physicians using st and ardized methods to judge whether the readmission was an adverse event ( poor clinical outcome due to medical care ) and whether the adverse event could have been avoided . We used a latent class model to determine whether the probability that each readmission was truly avoidable exceeded 50 % . Results : Of the 4812 patients included in the study , 649 ( 13.5 % , 95 % confidence interval [ CI ] 12.5%–14.5 % ) had an urgent readmission within six months after discharge . We considered 104 of them ( 16.0 % of those readmitted , 95 % CI 13.3%–19.1 % ; 2.2 % of those discharged , 95 % CI 1.8%–2.6 % ) to have had a potentially avoidable readmission . The proportion of patients who had an urgent readmission varied significantly by hospital ( range 7.5%–22.5 % ; χ2 = 92.9 , p < 0.001 ) ; the proportion of readmissions deemed avoidable did not show significant variation by hospital ( range 1.2%–3.7 % ; χ2 = 12.5 , p < 0.25 ) . We found no association between the proportion of patients who had an urgent readmission and the proportion of patients who had an avoidable readmission ( Pearson correlation 0.294 ; p = 0.38 ) . In addition , we found no association between hospital rankings by proportion of patients readmitted and rankings by proportion of patients with an avoidable readmission ( Spearman correlation coefficient 0.28 , p = 0.41 ) . Interpretation : Urgent readmissions deemed potentially avoidable were relatively uncommon , comprising less than 20 % of all urgent readmissions following hospital discharge . Hospital-specific proportions of patients who were readmitted were not related to proportions with a potentially avoidable readmission Background : Readmissions to hospital are common , costly and often preventable . An easy-to-use index to quantify the risk of readmission or death after discharge from hospital would help clinicians identify patients who might benefit from more intensive post-discharge care . We sought to derive and vali date an index to predict the risk of death or unplanned readmission within 30 days after discharge from hospital to the community . Methods : In a prospect i ve cohort study , 48 patient-level and admission-level variables were collected for 4812 medical and surgical patients who were discharged to the community from 11 hospitals in Ontario . We used a split- sample design to derive and vali date an index to predict the risk of death or nonelective readmission within 30 days after discharge . This index was externally vali date d using administrative data in a r and om selection of 1 000 000 Ontarians discharged from hospital between 2004 and 2008 . Results : Of the 4812 participating patients , 385 ( 8.0 % ) died or were readmitted on an unplanned basis within 30 days after discharge . Variables independently associated with this outcome ( from which we derived the nmemonic “ LACE ” ) included length of stay ( “ L ” ) ; acuity of the admission ( “ A ” ) ; comorbidity of the patient ( measured with the Charlson comorbidity index score ) ( “ C ” ) ; and emergency department use ( measured as the number of visits in the six months before admission ) ( “ E ” ) . Scores using the LACE index ranged from 0 ( 2.0 % expected risk of death or urgent readmission within 30 days ) to 19 ( 43.7 % expected risk ) . The LACE index was discriminative ( C statistic 0.684 ) and very accurate ( Hosmer – Lemeshow goodness-of-fit statistic 14.1 , p = 0.59 ) at predicting outcome risk . Interpretation : The LACE index can be used to quantify risk of death or unplanned readmission within 30 days after discharge from hospital . This index can be used with both primary and administrative data . Further research is required to determine whether such quantification changes patient care or outcomes The goal of this study was to prevent rehospitalizations and thus to optimize satisfaction with treatment and quality of life in patients suffering by schizophrenia or schizoaffective disorder . A complex intervention with improved cooperation between in- and outpatient services was applied to 46 “ high utilizing ” patients after discharge from inpatient care during an intervention phase of 6 months . The study was controlled by a matched group of 47 patients receiving treatment as usual .  The intervention was based on a computerized decision support module .  Eight psychiatrists in private practice s were supplied with this software to obtain guideline -based recommendations according to current psychopathology and clinical state . Suggested complex interventions by the software included psychoeducation , social competence group therapy , integrated psychological therapy , computer-based cognitive training , coping skills training , sociotherapy , nursing care , home visits , social-worker care , assistance to family members , and the use of an emergency call-in line . A local hospital project team arranged specifically suggested interventions . We intended to accomplish a reduction of rehospitalization rates by 50 % in the intervention group within a 12-month follow-up phase . Satisfaction with treatment , subjective quality of life , and treatment costs in terms of daily inpatient costs were compared between both groups . Moderator variables such as socio-demographical aspects or influences of certain interventions to rehospitalization rate were analyzed . The sample included patients more seriously ill than originally expected . Subjects in the control group ( CG ) were older ( 46 years ) than those subjects in the intervention group ( IG ) ( 40 years ) . Other sociodemographical aspects ( sex , family status , level of education , and number of former hospitalizations ) showed no differences between both groups . The rehospitalization rate and the mean length of inpatient treatment were reduced to nearly 50 % in the intervention group . The rate of readmissions increased in the control group , leading to a difference of 23 % between both groups . The most important factor to favorably influence rehospitalization rates was the participation in coping skills training . There was an increase in patient satisfaction with treatment , while the subjective quality of life remained constant . Since these improvements were accomplished with lower costs ( in terms of inpatient care ) , cost effectiveness was higher in the IG than in the CG . The most important single factor to favorably influence rehospitalization rates was the participation in coping skills training . Only the guideline consistent complex therapies as common intervention caused the significant overall result . Thereby , satisfaction with treatment increased considerably during the 6 months of intervention and remained constant during 12 months of follow up . The model project described is an important step to gain evidence and experience with integrated care for patients with schizophrenia BACKGROUND Few psychosocial interventions have been developed in China that are suitable for use in the community . AIMS To evaluate the effectiveness of the Chinese version of the Community Re-Entry Module ( CRM ; a module of a st and ardised , structured social skills training programme devised at the University of California , Los Angeles ) for patients with schizophrenia compared with st and ard group psychoeducation . METHOD Patients with schizophrenia ( n=103 ) were r and omly allocated to CRM or psychoeducation groups and followed up for 24 months . Outcome measures included social functioning , psychiatric symptoms , insight , re-employment , relapse and re-hospitalisation rates . RESULTS The CRM group significantly improved in terms of social functioning , insight and psychiatric symptoms compared with the psychoeducation group ; the re-employment rate was significantly higher and relapse and rehospitalisation rates were significantly lower in the CRM group . CONCLUSIONS The findings support the feasibility and effectiveness of CRM as a psychosocial intervention for Chinese patients with schizophrenia in the community A true experimental , posttest only , control group design was used to pilot test the effectiveness of a telephone nursing intervention in increasing community survival , and decreasing the number and length of rehospitalizations for persons with schizophrenia . The vulnerability model was used as a framework for the study . The intervention was hypothesized to function as a moderating factor to reduce the effects of stress on vulnerable persons with schizophrenia . Experimental subjects received telephone nursing intervention weekly for 3 months ;  control subjects received informational calls at weeks 6 and 12 .  Readmission rates were 13 % ( n = 2 ) for experimental subjects and 23 % ( n = 5 ) for controls . Compared with controls , experimental subjects experienced a 4 % increase in community survival and a 27 % reduction in length of stay if readmission occurred . These preliminary data suggest that telephone intervention can increase community survival in persons with schizophrenia . Future studies should focus on increasing sample size and refining the intervention Objective : This study was to investigate factors influencing the length of stay and predictors for the  risk of readmission at an acute psychiatric inpatient unit . Method : Two comparative studies were embedded in a retrospective cross-sectional clinical file audit . A r and omly selected 226 episodes of admissions including 178 patients during a twelve-month period were review ed . A total of 286 variables were collected and analysed . A case control study was employed in the study of length of stay . A retrospective cohort study was used to investigate the predictors for the risk of readmission . Results : Logistic regression analyses showed that 10 variables were associated with length of stay . Seclusion during the index admission , accommodation problems and living in an area lacking community services predicted longer stay . During the follow-up period 82 patients ( 46 % ) were readmitted . Cox regression analyses showed 9 variables were related to the risk of readmission . Six of these variables increased the risk of readmission , including history of previous frequent admission , risk to others at the time of the index admission and alcohol intoxication . More active and assertive treatment in the community post-discharge decreased the risk of readmission . Conclusions : Length of stay is multifactorially determined . Behavioural manifestations of illness and lack of social support structures predicted prolonged length of stay . Good clinical practice did not necessarily translate to a shorter length of stay . Therefore , length of stay is predictable , but not readily modifiable within the clinical domain . Good clinical practice within the community following discharge likely reduces the risk of readmission . Quality of inpatient care does not influence the risk of readmission , which therefore raises a question about the validity of using the rate of readmission as an outcome measure of psychiatric inpatient care This pilot r and omized control trial was motivated by the discovery that many individuals with mental health problems are re-hospitalized within a year , with many being unable to fully adjust to community living . A solution was proposed in the form of an intervention called transitional discharge . The transitional discharge model included : ( 1 ) peer support , which is assistance from former patients who provide friendship , underst and ing and encouragement ; and ( 2 ) overlap of inpatient and community staff in which the inpatient staff continue to work with the discharged patient until a working relationship is established with a community care provider . The overall aim of this study was to test the discharge model design ed to assist patients discharged from acute admission wards to adjust to community living . This aim was tested through a number of related hypotheses , which suggest that , 5 months following discharge from an acute admission ward of a psychiatric hospital , individuals participating in a transitional discharge model : ( 1 ) report fewer symptoms ; ( 2 ) report better levels of functioning ; ( 3 ) have better quality of life ; ( 4 ) are less likely to have been re-admitted to hospital . The study used a r and omized experimental design with two conditions : experimental and usual treatment . In general , both the control and the experimental group demonstrated significant improvements in symptom severity and functional ability after 5 months . Usual treatment subjects in the control group were more than twice as likely to be re-admitted to hospital . This study needs to be replicated in Scotl and with a larger sample and with a modified variation of the intervention called the Transitional Care Intervention OBJECTIVES This study tested the accuracy of models for predicting  rehospitalization  in a managed behavioral health organization and tested the effectiveness of different care management strategies for enhancing outpatient treatment follow-up . METHODS In a controlled study , patients with an inpatient mental health or substance use admission received one of three types of care management , distinguished by the level of care managers ' involvement in discharge planning and postdischarge outreach : usual ( N=31 ) , enhanced ( N=94 ) , and intensive ( N=74 ) . The groups were compared with each other and with a cohort admitted in the year before the study that received usual care management ( N=192 ) to determine whether differences existed in time to outpatient follow-up , amount of postdischarge care , and rehospitalization at 30 , 60 , and 180 days . RESULTS No differences between groups were found . The majority of patients ( 69 percent ) received outpatient care within 30 days of discharge . Prediction models using logistic regression suggested that the number of clinical and sociodemographic risk factors identified by care managers was related to the rate of rehospitalization at 60 and 180 days . Patients authorized to receive intermediate care ( partial hospitalization or residential care ) and those who failed to attend intermediate care if it was authorized were more likely than other patients to be rehospitalized at 30 , 60 , and 180 days . CONCLUSIONS Outpatient follow-up after psychiatric hospitalization did not improve with increasingly intensive discharge planning and outreach . Improvement in prediction of risk of rehospitalization may increase opportunities to provide intensive interventions for difficult-to-engage patients The objective 
    Output:
    
Many effective transitional intervention components are feasible and likely to be cost-effective .