***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 R and omized controlled trials , evidence -based medicine , clinical guidelines , and total quality management are some of the approaches used to render science-based health care services . The clinical pathway for hospitalized patients suffering from acute exacerbations of chronic obstructive pulmonary disease ( AE COPD ) is poorly established , although a clinical pathway is an integral part of total quality management . Aim To evaluate the outcomes of patients hospitalized with AE COPD in Japan , treated with a clinical pathway following published guidelines . Methods Prospect i ve data were collected for patients with AE COPD admitted to a general hospital over a 5-year period since 2003 . The clinical pathway was design ed to establish general rules for the entire treatment protocol . The clinical pathway indicates which treatments and interventions should be performed , and when . In this study , health care providers were required to check the clinical pathway sheets to determine the next step of treatment . Results This study analyzed 276 hospitalizations in 165 patients . The clinical pathway was interrupted and defined as a dropout in 45 cases ( 16.3 % ) . Nine patients died during hospitalization ( 3.3 % ) . Oxygen was administered in 232 hospitalizations ( 84.1 % ) .  Noninvasive positive pressure ventilation  ( NPPV ) treatment was administered in 110 hospitalizations ( 39.9 % ) . The rate of intubation in those cases where NPPV treatment had been administered was 8.2 % ( 9 cases out of 110 ) . The average length of stay ( LOS ) was 20.3 days , and the median value was 15 days . The LOS was longer than 30 days in 34 admissions ( 12.3 % ) , mainly due to complications . Conclusion AE COPD can be managed using a clinical pathway . This clinical pathway could fill the gap between guidelines and clinical practice Background Exacerbations , a leading cause of hospitalization in patients with chronic obstructive pulmonary disease ( COPD ) , affect the quality of life and prognosis . Treatment recommendations as provided in the evidence -based guidelines are not consistently followed , partly due to absence of simplified task-oriented approach to care . In this study , we describe the development and implementation of a clinical pathway ( CP ) and evaluate its effectiveness in the management of COPD exacerbation . Methods We developed a CP and evaluated its effectiveness in a non-r and omized prospect i ve study with historical controls on patients admitted for exacerbation of COPD to Universiti Kebangsaan Malaysia Medical Centre ( UKMMC ) . Consecutive patients who were admitted between June 2009 and December 2010 were prospect ively recruited into the CP group . Non-CP historical controls were obtained from case records of patients admitted between January 2008 and January 2009 . Clinical outcomes were evaluated by comparing the length of stay ( LOS ) , complication rates , readmissions , and mortality rates . Results Ninety-five patients were recruited in the CP group and 98 patients were included in the non-CP historical group . Both groups were comparable with no significant differences in age , sex and severity of COPD ( p = 0.641 ) . For clinical outcome measures , patients in the CP group had shorter length of stay than the non-CP group ( median ( IQR ) : 5 ( 4–7 ) days versus 7 ( 7–9 ) days , p < 0.001 ) and 24.1 % less complications ( 14.7 % versus 38.8 % , p < 0.001 ) . We did not find any significant differences in readmission and mortality rates . Conclusion The implementation of CP –reduced  the length of stay and complication rates of patients hospitalized for acute exacerbation of COPD OBJECTIVE : To test the cost effectiveness of  Hospital in the Home  compared to hospital admission for acute medical conditions BACKGROUND We assessed patient outcomes 90 days after hospital admission for stroke following a multidisciplinary intervention targeting evidence -based management of fever , hyperglycaemia , and swallowing dysfunction in acute stroke units ( ASUs ) . METHODS In the Quality in Acute Stroke Care ( QASC ) study , a single-blind cluster r and omised controlled trial , we r and omised ASUs ( clusters ) in New South Wales , Australia , with immediate access to CT and on-site high dependency units , to intervention or control group . Patients were eligible if they spoke English , were aged 18 years or older , had had an ischaemic stroke or intracerebral haemorrhage , and presented within 48 h of onset of symptoms . Intervention ASUs received treatment protocol s to manage fever , hyperglycaemia , and swallowing dysfunction with multidisciplinary team building workshops to address implementation barriers . Control ASUs received only an abridged version of existing guidelines . We recruited pre-intervention and post-intervention patient cohorts to compare 90-day death or dependency ( modified Rankin scale [ mRS ] ≥2 ) , functional dependency ( Barthel index ) , and SF-36 physical and mental component summary scores . Research assistants , the statistician , and patients were masked to trial groups . All analyses were done by intention to treat . This trial is registered at the Australia New Zeal and Clinical Trial Registry ( ANZCTR ) , number ACTRN12608000563369 . FINDINGS 19 ASUs were r and omly assigned to intervention ( n=10 ) or control ( n=9 ) . Of 6564 assessed for eligibility , 1696 patients ' data were obtained ( 687 pre-intervention ; 1009 post-intervention ) . Results showed that , irrespective of stroke severity , intervention ASU patients were significantly less likely to be dead or dependent ( mRS ≥2 ) at 90 days than control ASU patients ( 236 [ 42 % ] of 558 patients in the intervention group vs 259 [ 58 % ] of 449 in the control group , p=0·002 ; number needed to treat 6·4 ; adjusted absolute difference 15·7 % [ 95 % CI 5·8 - 25·4 ] ) . They also had a better SF-36 mean physical component summary score ( 45·6 [ SD 10·2 ] in the intervention group vs 42·5 [ 10·5 ] in the control group , p=0·002 ; adjusted absolute difference 3·4 [ 95 % CI 1·2 - 5·5 ] ) but no improvement was recorded in mortality ( 21 [ 4 % ] of 558 in intervention group and 24 [ 5 % ] of 451 in the control group , p=0·36 ) , SF-36 mean mental component summary score ( 49·5 [ 10·9 ] in the intervention group vs 49·4 [ 10·6 ] in the control group , p=0·69 ) or functional dependency ( Barthel Index ≥60 : 487 [ 92 % ] of 532 patients vs 380 [ 90 % ] of 423 patients ; p=0·44 ) . INTERPRETATION Implementation of multidisciplinary supported evidence -based protocol s initiated by nurses for the management of fever , hyperglycaemia , and swallowing dysfunction delivers better patient outcomes after discharge from stroke units . Our findings show the possibility to augment stroke unit care . FUNDING National Health & Medical Research Council ID 353803 , St Vincent 's Clinic Foundation , the Curran Foundation , Australian Diabetes Society-Servier , the College of Nursing , and Australian Catholic University Background The incidence of hip fracture is expected to increase during the coming years , dem and ing greater re sources and improved effectiveness on this group of patients . The aim of the present study was to evaluate the effectiveness of an  integrated care pathway ( ICP ) in patients with an acute fracture of the hip . Methods A nonr and omized prospect i ve study comparing a consecutive series of patients treated by the conventional pathway to a newer intervention . 112 independently living patients aged 65 years or older admitted to the hospital with a hip fracture were consecutively selected . Exclusion criteria were pathological fracture and severe cognitive impairment . An ICP was developed with the intention of creating a care path with rapid pre-operative attention , increased continuity and an accelerated training programme based on the individual patient 's prerequisites and was used as a guidance for each patient 's tailored care in the intervention group ( N = 56 ) The main outcome measure was the length of hospital stay . Secondary outcomes were the amount of time from the emergency room to the ward , to surgery and to first ambulation , as well as in-hospital complications and 30-day readmission rate . Results The intervention group had a significantly shorter length of hospital stay ( 12.2 vs. 26.3 days ; p < 0.000 ) , a shorter time to first ambulation ( 41 vs. 49 h ; p = 0.01 ) , fewer pressure wounds ( 8 vs. 19 ; p = 0.02 ) and medical complications ( 5 vs. 14 ; p = 0.003 ) than the comparison group . No readmissions occurred within 30 days post-intervention in either group . Conclusion Implementing an ICP for patients with a hip fracture was found to significantly reduce the length of hospital stay and improve the quality of care BACKGROUND / PURPOSE Appendicitis is the most common surgical emergency in children . However , management varies widely . The aim of this study was to assess the impact of introducing a care pathway on the management of childhood appendicitis . METHODS Data were collected prospect ively for 3 successive cohorts : All patients operated for suspected appendicitis were included . The pathway was modified after interim analysis of group B data . P < .05 was significant . RESULTS Six hundred patients were included . When compared with group A , group C patients were more likely to receive  preoperative antibiotics  ( P < .0001 ) , undergo  formal pain assessment ( P < .0001 ) , and be operated before midnight ( P = .025 ) . There was a significant decrease in readmission rates from 10.0 % to 4.2 % ( P = .023 ) despite an increase in cases of gangrenous and perforated appendicitis ( P = .010 ) . CONCLUSIONS The introduction of a care pathway result ed in improved compliance with antibiotic regimens , more frequent pain assessment , and fewer post-midnight operations . Postappendicectomy readmission rates were reduced despite an increase in disease severity . This was achieved by critical reevaluation of outcomes and pathway re design where appropriate Background : Chronic obstructive pulmonary disease ( COPD ) generates a high burden on health care , and hospital admissions represent a substantial proportion of the overall costs of the disease . Integrated care ( IC ) has shown efficacy to reduce hospitalisations in COPD patients at a pilot level . Deployment strategies for IC services require assessment of effectiveness at the health care system level . Aims : The aim of this study was to explore the effectiveness of a community-based IC service in preventing hospitalisations and emergency department ( ED ) visits in stable frail COPD patients . Methods : From April to December 2005 , 155 frail community-dwelling COPD patients were r and omly allocated either to IC ( n=76 , age 73 ( 8) years , forced expiratory volume during the first second , FEV1 41(19 ) % predicted ) or usual care ( n=84 , age 75(9 ) years , FEV1 44 ( 20 ) % predicted ) and followed up for 12 months . The IC intervention consisted of the following : ( a ) patient ’s empowerment for self-management ; ( b ) an individualised care plan ; ( c ) access to a call centre ; and ( d ) coordination between the levels of care . Thereafter , hospital admissions , ED visits and mortality were monitored for 6 years . Results : IC  enhanced self-management ( P=0.02 ) , reduced anxiety – depression ( P=0.001 ) and improved health-related quality of life ( P=0.02 ) . IC reduced both ED visits ( P=0.02 ) and mortality ( P=0.03 ) but not hospital admission . No differences between the two groups were seen after 6 years . Conclusion : The intervention improved clinical outcomes including survival and decreased the ED visits , but it did not reduce hospital admissions . The study facilitated the identification of two key requirements for adoption of IC services in the community : appropriate risk stratification of patients , and preparation of the community-based work force Clinical pathways are developed colla boratively by clinicians , nurses , pharmacists and other allied health-care professionals , with the aim of improving the quality of patient care and applying an agreed , st and ardised , ‘ best management ’ plan INTRODUCTION Diabetic foot ulcers are a feared complication of diabetes . Care delivered via telemedicine is suggested to be a more integrated care pathway to manage diabetic foot ulcers than traditionally delivered healthcare . Our aim was to explore patients ' experiences with telemedicine follow-up care as compared to traditional care . METHODS Interpretive description was used as an analysis strategy . Data were collected using individual semi-structured interviews in the context of a larger ongoing clustered r and omized controlled trial . Twenty-four patients ( 13 in the intervention group ; 11 in the control group ) , aged 38 - 88 years were purposively recruited from the RCT in order to obtain a diverse sample in terms of group composition ( intervention vs. control ) , age , gender , marital status , setting , and comorbidities present . The control group received traditional care . RESULTS Three themes emerged from the interpretive analysis : competence of healthcare professionals , continuity of care , and easy access . This was independed of types of follow-up that had limited impact on the patients ' follow-up experiences . Competence of healthcare professionals and continuity of care were crucial , because they can either enhance or jeopardize 
    Output:
    
Outcome indicators were more frequent than other indicators .
Complication rate , hospital costs and length of hospital stay were dominant in their own category .
Conclusion : Implementing CPW can affect different types of indicators such as input , process , output and outcome indicators , although outcome indicators capture more attention than other indicators .
Patient-related indicators were dominant outcome indicators , whereas professional indicators and organizational factors were considered less extensively .