***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: The present study evaluated a new integrated treatment concept offering inpatient care , acute psychiatric day hospital and outpatient treatment by the same therapeutic team . 178 patients participated in this r and omized controlled trial . Data on psychopathology , global and social functioning , patient satisfaction , continuity of care and administrative data was gathered on admission , throughout the course of treatment , upon discharge and at 1-year follow-up . In addition , the physicians in charge rated the therapeutic relationship . The data analysis consists of group-wise comparisons and regression analyses ( cross-tabulations and χ2 test statistics for categorical data and Mann – Whitney U tests for continuous data ) . Differences between groups over time were analyzed with a series of generalized linear mixed model . The integrated care group showed a significant reduction in psychopathological impairment ( 20.7 % ) and an improvement of psychosocial functioning ( 36.8 % ) . The mean number of days before re-admission was higher in the control group when compared to the integrated care group ( 156.8 vs. 91.5 ) . There was no difference in the number of re-admissions and days spent in psychiatric institutions . This new approach offers a treatment model , which facilitates continuity of care . Beside it improves psychopathological outcome measures and psychosocial functioning in patients with mental illness Objectives To evaluate the association between the degree of integration in  community mental health teams ( CMHTs )  and : ( i ) the costs of service provision ; ( ii ) rates of mental health inpatient and care home admission . Methods An observational study of service use and admissions to institutional care was undertaken for a prospect ively‐ sample d cohort of patients from eight CMHTs in Engl and . Teams were chosen to represent ‘ high ’ or ‘ low ’ levels of integrated working practice and patients were followed‐up for seven months . General linear models were used to estimate service costs and the likelihood of institutional admission . Results Patients supported by high integration teams received services costing an estimated 44 % more than comparable patients in low integration teams . However , after controlling for case mix , no significant differences were found in the likelihood of admission to mental health inpatient wards or care homes between team types . Conclusions Integrated mental health and social care teams appeared to facilitate greater access to community care services , but no consequent association was found with community tenure . Further research is required to identify the necessary and sufficient components of integrated community mental health care , and its effect on a wider range of outcomes using patient‐reported measures . © 2016 The Authors . International Journal of Geriatric Psychiatry published by John Wiley & Sons , IMPORTANCE Accountable care contracts hold physician groups financially responsible for the quality and cost of health care delivered to patients . Focusing on clinical ly vulnerable patients , those with serious conditions who are responsible for the greatest proportion of spending , may result in the largest effects on both patient outcomes and financial rewards for participating physician groups . OBJECTIVE To estimate the effect of Medicare accountable care organization ( ACO ) contracts on spending and high-cost institutional use for all Medicare beneficiaries and for clinical ly vulnerable beneficiaries . DESIGN , SETTING , AND PARTICIPANTS For this cohort study , 2 study population s were defined : the overall Medicare population and the clinical ly vulnerable subgroup of Medicare beneficiaries . The overall Medicare population was based on a r and om 40 % sample drawn from continuously enrolled fee-for-service beneficiaries with at least 1 evaluation and management visit in a calendar year . The clinical ly vulnerable study population included all Medicare beneficiaries 66 years or older who had at least 3 Hierarchical Condition Categories ( HCCs ) . Beneficiaries entered the cohort during the quarter between January 2009 to December 2011 when they first had at least 3 HCCs and remained in the cohort until death . Cohort entry was restricted to the preperiod to account for potential changes in coding practice s after ACO implementation . Difference-in-difference estimations were used to compare changes in health care outcomes for Medicare beneficiaries attributed to physicians in ACOs with those attributed to non-ACO physicians from January 2009 to December 2013 . EXPOSURES Medicare ACOs beginning contracts in January 2012 , April 2012 , July 2012 , and January 2013 through the Pioneer and Medicare Shared Savings Programs . MAIN OUTCOMES AND MEASURES Total spending per beneficiary-quarter , spending categories , use of hospitals and emergency departments , ambulatory care sensitive admissions , and 30-day readmissions . RESULTS Total spending decreased by $ 34 ( 95 % CI , -$52 to -$15 ) per beneficiary-quarter after ACO contract implementation across the overall Medicare population ( n = 15 592 600 ) and decreased $ 114 in clinical ly vulnerable patients ( n = 8 673 823 ) ( 95 % CI , -$178 to -$50 ) . In the overall Medicare cohort , hospitalizations and emergency department visits decreased by 1.3 and 3.0 events per 1000 beneficiaries per quarter , respectively ( 95 % CIs : -2.1 to -0.4 and -4.8 to -1.3 ) , and hospitalizations and emergency department visits decreased in the clinical ly vulnerable cohort by 2.9 and 4.1 events per 1000 beneficiaries per quarter , respectively ( 95 % CIs : -5.2 to -0.7 and -7.1 to -1.2 ) . Changes in total spending associated with ACOs did not vary by clinical condition of beneficiaries . CONCLUSIONS AND RELEVANCE Medicare ACO programs are associated with modest reductions in spending and use of hospitals and emergency departments . Savings were realized through reductions in use of institutional setting s in clinical ly vulnerable patients Background : “ Referral ” characterises a significant area of interaction between primary and secondary care . Despite advantages , it can be inflexible , and may lead to duplication . Objective : To examine the outcomes of an integrated model that lends weight to general practitioner (GP)-led evidence based care . Design : A prospect i ve , non-r and om comparison of two services : women attending the new ( Bridges ) pathway compared with those attending a consultant-led one-stop menstrual clinic ( OSMC ) . Patients ’ views were examined using patient career diaries , health and clinical outcomes , and re source utilisation . Follow-up was for 8 months . Setting : A large teaching hospital and general practice s within one primary care trust ( PCT ) . Results : Between March 2002 and June 2004 , 99 women in the Bridges pathway were compared with 94 women referred to the OSMC by GPs from non-participating PCTs . The patient career diary demonstrated a significant improvement in the Bridges group for patient information , fitting in at the point of arrangements made for the patient to attend hospital ( ease of access ) ( p<0.001 ) , choice of doctor ( p = 0.020 ) , waiting time for an appointment ( p<0.001 ) , and less “ limbo ” ( patient experience of non-coordination between primary and secondary care ) ( p<0.001 ) . At 8 months there were no significant differences between the two groups in surgical and medical treatment rates or in the use of GP clinic appointments . Significantly fewer ( traditional ) hospital outpatient appointments were made in the Bridges group than in the OSMC group ( p<0.001 ) . Conclusion : A general practice -led model of integrated care can significantly reduce outpatient attendance while improving patient experience , and maintaining the quality of care CONTEXT Most older adults with dementia will be cared for by primary care physicians , but the primary care practice environment presents important challenges to providing quality care . OBJECTIVE To test the effectiveness of a collaborative care model to improve the quality of care for patients with Alzheimer disease . DESIGN , SETTING , AND PATIENTS Controlled clinical trial of 153 older adults with Alzheimer disease and their caregivers who were r and omized by physician to receive collaborative care management ( n = 84 ) or augmented usual care ( n = 69 ) at primary care practice s within 2 US university-affiliated health care systems from January 2002 through August 2004 . Eligible patients ( identified via screening or medical record ) met diagnostic criteria for Alzheimer disease and had a self-identified caregiver . INTERVENTION Intervention patients received 1 year of care management by an interdisciplinary team led by an advanced practice nurse working with the patient 's family caregiver and integrated within primary care . The team used st and ard protocol s to initiate treatment and identify , monitor , and treat behavioral and psychological symptoms of dementia , stressing nonpharmacological management . MAIN OUTCOME MEASURES Neuropsychiatric Inventory ( NPI ) administered at baseline and at 6 , 12 , and 18 months . Secondary outcomes included the Cornell Scale for Depression in Dementia ( CSDD ) , cognition , activities of daily living , re source use , and caregiver 's depression severity . RESULTS Initiated by caregivers ' reports , 89 % of intervention patients triggered at least 1 protocol for behavioral and psychological symptoms of dementia with a mean of 4 per patient from a total of 8 possible protocol s. Intervention patients were more likely to receive  cholinesterase inhibitors  ( 79.8 % vs 55.1 % ; P = .002 ) and  antidepressants  ( 45.2 % vs 27.5 % ; P = .03 ) . Intervention patients had significantly fewer behavioral and psychological symptoms of dementia as measured by the total NPI score at 12 months ( mean difference , -5.6 ; P = .01 ) and at 18 months ( mean difference , -5.4 ; P = .01 ) . Intervention caregivers also reported significant improvements in distress as measured by the caregiver NPI at 12 months ; at 18 months , caregivers showed improvement in depression as measured by the Patient Health Question naire-9 . No group differences were found on the CSDD , cognition , activities of daily living , or on rates of hospitalization , nursing home placement , or death . CONCLUSIONS Collaborative care for the treatment of Alzheimer disease result ed in significant improvement in the quality of care and in behavioral and psychological symptoms of dementia among primary care patients and their caregivers . These improvements were achieved without significantly increasing the use of antipsychotics or sedative-hypnotics . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00246896 OBJECTIVE T o examine whether quality of care ( QOC ) improves when nurse practitioners and pharmacists work with family physicians in community practice and focus their work on patients who are 50 years of age and older and considered to be at risk of experiencing adverse health outcomes . DESIGN R and omized controlled trial . SETTING A family health network with 8 family physicians , 5 nurses , and 11 administrative personnel serving 10 000 patients in a rural area near Ottawa , Ont . PARTICIPANTS Patients 50 years of age and older at risk of experiencing adverse health outcomes ( N = 241 ) . INTERVENTIONS At-risk patients were r and omly assigned to receive usual care from their family physicians or Anticipatory and Preventive Team Care ( APTCare ) from a collaborative team composed of their physicians , 1 of 3 nurse practitioners , and a pharmacist . MAIN OUTCOME MEASURES Quality of care for chronic disease management ( CDM ) for diabetes , coronary artery disease , congestive heart failure , and chronic obstructive pulmonary disease . RESULTS Controlling for baseline demographic characteristics , the APTCare approach improved CDM QOC by 9.2 % ( P < .001 ) compared with traditional care . The APTCare intervention also improved preventive care by 16.5 % ( P < .001 ) . We did not observe significant differences in other secondary outcome measures ( intermediate clinical outcomes , quality of life [ Short-Form 36 and health-related quality of life scales ] , functional status [ instrumental activities of daily living scale ] and service usage ) . CONCLUSION Additional re sources in the form of collaborative multidisciplinary care teams with intensive interventions in primary care can improve QOC for CDM in a population of older at-risk patients . The appropriateness of this intervention will depend on its cost-effectiveness . TRIAL REGISTRATION NUMBER NCT00238836 ( CONSORT ) OBJECTIVE To document outcomes of a r and omized trial of the PhoenixCare demonstration program of palliative care and coordinated care/case management for seriously chronically ill individuals who simultaneously received active treatment from managed care organizations ( MCOs ) . DESIGN Patients , continuously enrolled between July 1999 , and March 2001 , were r and omly assigned to the PhoenixCare program  or a control group receiving usual MCO care . SETTING Hospice of the Valley , Phoenix , Arizona . PARTICIPANTS Participants were 192 patients with chronic obstructive pulmonary disease ( COPD ) or chronic heart failure ( CHF ) , who had an estimated 2-year life expectancy . INTERVENTION Intensive home-based case management provided by registered nurse casemanagers , in coordination with patients ' existing source of medical care , comprised the intervention . Program foci included disease and symptom management , patient self-management of illness and knowledge of illness-related re sources , preparation for end-of life , physical and mental functioning , and utilization of medical services . OUTCOME MEASURES Outcomes , assessed every 3 months by telephone interview , included measures related to all program foci ; the SF-36 was used to evaluate physical and mental functioning ; emergency department visits exemplified medical service utilization . RESULTS Compared to controls , PhoenixCare patients exhibited significantly better outcomes on self-management of illness , awareness of illness-related re sources , and legal preparation for end of life . They reported 
    Output:
    
Analysis indicated evidence of perceived improved quality of care , evidence of increased patient satisfaction , and evidence of improved access to care .
Evidence was rated as either inconsistent or limited regarding all other outcomes reported , including system-wide impacts on primary care , secondary care , and health care costs .
Conclusions Models of integrated care may enhance patient satisfaction , increase perceived quality of care , and enable access to services , although the evidence for other outcomes including service costs remains unclear .