***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: CONTEXT Comprehensive discharge planning by advanced practice nurses has demonstrated short-term reductions in readmissions of elderly patients , but the benefits of more intensive follow-up of hospitalized elders at risk for poor outcomes after discharge has not been studied . OBJECTIVE To examine the effectiveness of an advanced practice nurse-centered discharge planning and home follow-up intervention for elders at risk for hospital readmissions .  DESIGN R and omized clinical trial with follow-up at 2 , 6 , 12 , and 24 weeks after index hospital discharge . SETTING Two urban , academically affiliated hospitals in Philadelphia , Pa. PARTICIPANTS Eligible patients were 65 years or older , hospitalized between August 1992 and March 1996 , and had 1 of several medical and surgical reasons for admission . INTERVENTION Intervention group patients received a comprehensive discharge planning and home follow-up protocol design ed specifically for elders at risk for poor outcomes after discharge and implemented by advanced practice nurses . MAIN OUTCOME MEASURES Readmissions , time to first readmission , acute care visits after discharge , costs , functional status , depression , and patient satisfaction . RESULTS A total of 363 patients ( 186 in the control group and 177 in the intervention group ) were enrolled in the study ; 70 % of intervention and 74 % of control subjects completed the trial . Mean age of sample was 75 years ; 50 % were men and 45 % were black . By week 24 after the index hospital discharge , control group patients were more likely than intervention group patients to be readmitted at least once ( 37.1 % vs 20.3 % ; P<.001 ) . Fewer intervention group patients had multiple readmissions ( 6.2 % vs 14.5 % ; P = .01 ) and the intervention group had fewer hospital days per patient ( 1.53 vs 4.09 days ; P<.001 ) . Time to first readmission was increased in the intervention group ( P<.001 ) . At 24 weeks after discharge , total Medicare reimbursements for health services were about $ 1.2 million in the control group vs about $ 0.6 million in the intervention group ( P<.001 ) . There were no significant group differences in post-discharge acute care visits , functional status , depression , or patient satisfaction . CONCLUSIONS An advanced practice nurse-centered discharge planning and home care intervention for at-risk hospitalized elders reduced readmissions , lengthened the time between discharge and readmission , and decreased the costs of providing health care . Thus , the intervention demonstrated great potential in promoting positive outcomes for hospitalized elders at high risk for rehospitalization while reducing costs Kenneth Coburn and colleagues report findings from a r and omized trial evaluating the effects of a complex nursing intervention on mortality risk among older individuals diagnosed with chronic health conditions Background Case management has been applied in community aged care to meet frail older people ’s holistic needs and promote cost-effectiveness . This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes . Methods We search ed Web of Science , Scopus , Medline , CINAHL ( EBSCO ) and PsycINFO ( CSA ) from inception to 2011 July . Inclusion criteria were : no restriction on date , English language , community-dwelling older people and /or carers , case management in community aged care , published in refereed journals , r and omized control trials ( RCTs ) or comparative observational studies , examining client or carer outcomes . Quality of studies was assessed by using such indicators as quality control , r and omization , comparability , follow-up rate , dropout , blinding assessors , and intention-to-treat analysis . Two review ers independently screened potentially relevant studies , extracted information and assessed study quality . A narrative summary of findings were presented . Results Ten RCTs and five comparative observational studies were identified . One RCT was rated high quality . Client outcomes included mortality ( 7 studies ) , physical or cognitive functioning ( 6 studies ) , medical conditions ( 2 studies ) , behavioral problems ( 2 studies ) , unmet service needs ( 3 studies ) , psychological health or well-being ( 7 studies ) , and satisfaction with care ( 4 studies ) , while carer outcomes included stress or burden ( 6 studies ) , satisfaction with care ( 2 studies ) , psychological health or well-being ( 5 studies ) , and social consequences ( such as social support and relationships with clients ) ( 2 studies ) . Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group , while all the three studies consistently reported fewer unmet service needs among the intervention participants . In contrast , available studies reported mixed results regarding client physical or cognitive functioning and carer stress or burden . There was also limited evidence indicating significant effects of the interventions on the other client and carer outcomes as described above . Conclusions Available evidence showed that case management in community aged care can improve client psychological health or well-being and unmet service needs . Future studies should investigate what specific components of case management are crucial in improving clients and their carers ’ outcomes Guided Care ( GC ) is an enhancement to primary care that incorporates the operative principles of disease management and chronic care innovations . In a 6-month quasi-experimental study , we compared the cost and utilization patterns of patients assigned to GC and Usual Care ( UC ) .  The setting was a community-based general internal medicine practice . The participants were patients of 4 general internists . They were older , chronically ill , community-dwelling patients , members of a capitated health plan , and identified as high risk . Using the Adjusted Clinical Groups Predictive Model ( ACG-PM ) , we identified those at highest risk of future health care utilization . We selected the 75 highest-risk older patients of 2 internists at a primary care practice to receive GC and the 75 highest-risk older patients of 2 other internists in the same practice to receive UC .  Insurance data were used to describe the groups ' demographics , chronic conditions , insurance expenditures , and utilization . Among our results , at baseline , the GC ( all targeted patients ) and UC groups were similar in demographics and prevalence of chronic conditions , but the GC group had a higher mean ACG-PM risk score ( 0.34 vs. 0.20 , p < 0.0001 ) . During the following 6 months , the GC group had lower unadjusted mean insurance expenditures , hospital admissions , hospital days , and emergency department visits ( p > 0.05 ) . There were larger differences in insurance expenditures between the GC and UC groups at lower risk levels ( at ACG-PM = 0.10 , mean difference = $ 4340 ; at ACG-PM = 0.6 , mean difference = $ 1304 ) . Thirty-one of the 75 patients assigned to receive GC actually enrolled in the intervention . These results suggest that GC may reduce insurance expenditures for high-risk older adults . If these results are confirmed in larger , r and omized studies , GC may help to increase the efficiency of health care for the aging American population AIM The purpose of this study was to test the effectiveness of a collaborative primary care nurse case management intervention emphasising collaboration between physicians , nurses and patients , risk identification , comprehensive assessment , collaborative planning , health monitoring , patient education and transitional care on healthcare utilisation and cost for community dwelling chronically ill older persons . BACKGROUND Primary care teams comprised of nurses and primary care physicians have been suggested as a model for providing quality care to the chronically ill , but this type of intervention has not been systematic ally evaluated . DESIGN A non-r and omised , 36 month comparison of two geographically distinct primary care population s was conducted . METHODS Six hundred and seventy-seven persons aged 65 and older were determined to be at high-risk for mortality , functional decline , or increased health service use . The treatment group ( n = 400 ) received  the intervention  and the  comparison group ( n = 277 ) received usual care . Health plan cl aims files provided data on number of hospitalisations and bed days , emergency department ( ED ) visits , physician visits and total cost of care . RESULTS After adjustment for baseline variables , there were no significant differences between the treatment and comparison group in the percentage of patients hospitalised or ED visits . However , among those hospitalised in the treatment group , the likelihood of being re-hospitalised was significantly reduced by 34 % ( p = 0·032 ) . After adjusting for the cost of the intervention , although not statistically significant , the reduced hospital use result ed in cost savings of $ 106 per patient per month in the treatment group . CONCLUSIONS The results indicate that a collaborative primary care nurse case management intervention has the potential to be an effective alternative to current primary care delivery system practice . RELEVANCE TO CLINICAL PRACTICE The study suggests that a chronic care intervention emphasising collaboration between physicians , nurses and patients , may be more effective when implemented in integrated provider networks 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 ) 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 
    Output:
    
Secondary subgroup analyses suggested the effectiveness of case management may be increased when delivered by a multidisciplinary team , when a social worker was involved , and when delivered in a setting rated as low in initial ' strength ' of primary care .
This was the first meta-analytic review which examined the effects of case management on a wide range of outcomes and considered also the effects of key moderators .
Current results do not support case management as an effective model , especially concerning reduction of secondary care use or total costs .