***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: We illustrate Fairweather 's approach to Experimental Social Innovation and Dissemination with two experimental studies of programs to reduce homelessness for 168 and 225 people with mental illness and often substance abuse . Literally homeless participants were r and omly assigned to programs that emphasized consumer choice or to the usual continuum of care , in which housing and services are contingent on sobriety and progress in treatment . A drop-in center that eliminated barriers to access to services was more successful than control programs in reducing homelessness , but after 24 months only 38 % of participants had moved to community housing . A subsequent apartment program , in which individuals in the experimental condition moved to subsidized apartments directly from the street , with services under their control , had 79 % in stable housing ( compared to 27 % in the control group ) at the end of 6 months . Groups in this study did not differ on substance abuse or psychosocial outcomes Ninety-one patients admitted as emergencies , suffering from neurosis , personality disorder , or adjustment reaction , were r and omly allocated to day hospital or to continued in-patient care . Follow-up was for up to one year . Clinical outcome was similar in the day care and in-patient groups , but patient satisfaction was significantly greater in day patients . Day hospital care was only about two-thirds of the cost of the cheaper of the two in-patient regimes , even though contact with it was on average twice as long as for in- patients An effort was made to determine patient characteristics that have differential prognostic significance , depending on treatment assignment to one of three treatment approaches :  st and ard inpatient care ( n = 63 ) , brief hospitalization followed by day care  ( n = 61 ) , and brief hospitalization without day care  ( n = 51 ) . All were followed by outpatient care . Both demographically and clinical ly assessed behavioral variables were related to a number of outcome measures , including days in the community , clinical ratings , and family assessment . Generally , the st and ard treatment was inferior to the two brief treatments . Multiple previous admissions were particularly contraindicative for st and ard treatment .  High overt anger score was especially contraindicative for brief hospitalization without day care and particularly indicative for brief hospitalization with day care The authors r and omly assigned 79 in patients with nonchronic schizophrenia or affective disorder to either an intensive experimental day program called " transitional treatment " or a control treatment -- weekly clinical ly believed to require intensive posthospital treatment to make the transition to the community . Although initially there was a significantly higher dropout rate from the control condition , at the point of discharge from the two programs as well as at 6- and 12-month follow-up there was no difference in outcome . Direct costs for the transitional treatment , however , were much higher This study measures the effect of a high-expectation and a low-expectation environment on discharged long-term mental patients r and omly assigned to one of two community setting s. The high-expectation setting includes a halfway house , a daytreatment center , and a rehabilitation workshop . It dem and s much in the way of mobility , planning , and accepting responsibility . Low-expectation patients go to boarding homes where docility is valued and little initiative is expected . The boardinghome group is not really in the community . It is like a small ward moved to a community setting . The high-expectation group has a higher rehospitalization rate , but a longer time out of the hospital with a higher level of instrumental performance . The high-expectation group is less segregated , is less likely to be labeled as deviate , and is less stigmatized A prospect i ve r and omized comparative study on the effectiveness of  psychiatric day treatment and inpatient treatment is described . The target population consisted of patients who would normally have been admitted to an open inpatient unit . Outcome indicators were psychopathology , social functioning , interpersonal functioning , social network and social support . No differences in effectiveness were found between the two forms of treatment , although more patients accepted and completed day treatment , and day patients were more satisfied . Although a uniform treatment programme for both departments was established , distinct differences did arise in the actual treatment programme offered to the patients . The duration of treatment for the day patients was considerably longer , and the intensity of treatment was more low‐key . No striking differences in the amount of medication prescribed and in the occurrence of crisis situations ( including suicide ) were found . Day treatment turns out to be a realistic alternative for 33 % of all patients admitted for inpatient treatment . It was not possible to predict which type of patient in particular is suitable for day treatment The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at each level of clustering . In these data , ICCs were inversely related to cluster size , but design effects could be substantial when the cluster size was large . Most ICCs were below 0.01 at the district health authority level , and they were mostly below 0.05 at the postal code sector level . At the household level , many ICCs were in the range of 0.0 - 0.3 . These data may provide useful information for the design of epidemiologic studies in which the units sample d or allocated range in size from households to large administrative areas The feasibility of  day treatment with community care for  schizophrenic patients was tested by means of a longitudinal r and omized experiment with 34 experimentals and 16 controls : 38 percent could be treated satisfactorily in a day program that included a very active ambulatory service . The new approach did not improve prognosis with respect to psychiatric symptomatology , social role disabilities , or number of readmissions during the first year of followup . Total cost of treatment was less for day-treatment patients than for ordinary clinical patients Acutely ill patients presenting for admission in two district psychiatric services were r and omly allocated to day-hospital or in-patient care . In both services a quarter of all admissions could not be allocated because they were too ill ( half of these were compulsory admissions ) ; these patients were predominantly manic and schizophrenic patients with pronounced psychotic symptoms and disturbed behaviour . In one service 80 % ( 41/51 ) of patients r and omly allocated to day-hospital treatment were successfully engaged in treatment compared with 54 % ( 19/35 ) in the other service . This difference arose because only patients with mildly disturbed behaviour could be treated at the second day hospital . For patients who were successfully allocated , the outcome of treatment was similar in terms of psychiatric symptoms and social functioning . The results of a treatment trial for acutely ill patients in one district service can not be generalised to other district services without due attention to the factors , such as staffing levels , which determine the degree of disturbed behaviour that can be tolerated in the day hospital Two long-term care setting s not now covered by Medicare — adult day care  and  homemaker services — were studied in a r and omized experiment to test the effects on patient outcomes and costs of using these new services . This article reports findings for day care . Patients ’ physical , psychosocial and health functions were assessed quarterly , and their Medicare bill files were obtained . Medicaid data were obtained on most patients , but few used many Medicaidcovered long-term care services . Multistage analysis was performed to mitigate effects of departures from the r and omized design . Day-care patients showed no benefits in physical functioning ability at the end of the study , compared with the control group . Institutionalization in skilled nursing facilities was lower for the experimental group than the control group , but factors other than the treatment variable appeared to explain most of the variance . There was a possibility that life was extended for some day-care patients . The new services averaged $ 52 per day or $ 3,235 per year . When costs for existing Medicare services used were added , the yearly cost of the experimental group was $ 6,501 , compared with $ 3,809 for the control group — an increase of $ 2,692 or 71 per cent Abstract Objective : To compare direct and indirect costs of day and inpatient treatment of acute psychiatric illness . Design : R and omised controlled trial with outcome and costs assessed over 12 months after the date of admission . Setting : Teaching hospital in an inner city area . Subjects : 179 patients with acute psychiatric illness referred for admission who were suitable for r and om allocation to day hospital or inpatient treatment . 77 ( 43 % ) patients had schizophrenia . Interventions : Routine inpatient or day hospital treatment . Main outcome measures : Direct and indirect costs over 12 months ; clinical symptoms , social functioning , and burden on relatives over the follow up period . Results : Clinical and social outcomes were similar at 12 months , except that in patients improved significantly faster than day patients and burden on relatives was significantly less in the day hospital group at one year . Median direct costs to the hospital were £ 1923 ( 95 % confidence interval £ 750 to £ 3174 ) per patient less for day hospital treatment than inpatient treatment . Indirect costs were greater for day patients ; when these were included , overall day hospital treatment was £ 2165 cheaper than inpatient treatment ( 95 % confidence interval of median difference £ 737 to £ 3593 ) . Including costs to informants when appropriate meant that day hospital treatment was £ 1994 per patient cheaper ( 95 % confidence interval £ 600 to £ 3543 ) . Conclusions : Day patient treatment is cheaper for the 30 - 40 % of potential admissions that can be treated in this way . Carers of day hospital patients may bear additional costs . Carers of all patients with acute psychiatric illness are often themselves severely distressed at the time of admission , but day hospital treatment leads to less burden on carers in the long term . Key messages When inpatient treatment is avoidable day hospital treatment is cheaper for acutely ill psychiatric patients Carers of acutely ill psychiatric patients experience severe distress and warrant help in their own right Inpatient treatment relieves symptoms more rapidly than day hospital treatment but may lead to increased burden on carers one year OBJECTIVE Rates of completion , complications , and outcome were examined in a sample of poorly functioning patients who participated in a group-oriented day treatment program for patients with personality disorders . METHODS The study was a naturalistic prospect i ve study of 183 patients admitted to a day treatment program in Oslo , Norway . The program consists of a combination of group analytically oriented groups and cognitive-behavioral groups . The Global Severity Index ( GSI ) of the Symptom Check List , the circumplex version of the  Inventory of Interpersonal Problems ( IIP-C ) , and the Global Assessment of Functioning ( GAF ) were administered at admission and discharge . RESULTS A total of 138 [ corrected ] patients ( 77 percent ) completed the day treatment program . Few patients experienced treatment complications . Effect sizes for GAF , GSI , and IIP-C scores for treatment completers were in the medium-to-high range , indicating a fair level of improvement . Patients ' rating of benefit was positive . CONCLUSIONS The results are promising as a first step toward development of a cost-efficient comprehensive long-term treatment program for patients with severe personality disorders The effectiveness of day care versus out-patient care in the treatment of persistent severe anxiety and depression was compared in a controlled clinical trial . Of 96 consecutively referred patients meeting the entry criteria , 92 were followed up for six months . Patients were r and omised to day care or out-patient care , and assessed at entry and at six months using the St and ardised Psychiatric Interview and in terms of their time structuring and socialisation . Marked improvement in all three measures was seen for most of the day patients , but for few of the out- patients : this difference was highly significant for each measure . Day patients also rated themselves as coping more effectively and as more satisfied with their treatment . These differences could not be explained by differences in use of medication . Day treatment should remain an option for patients with persistent anxiety and depression resistant to outpatient treatment A comprehensive system of community treatment in southwest Denver has reduced the need for adult psychiatric inpatient beds to less than 1/100,000 population .  Six small , community-based therapeutic environments , crisis intervention , home treatment , social systems intervention , and rapid tranquilization comprise the essential components of this total community care system . The system operates within a framework of citizen participation and community control , the elimination of formal staff offices , and a focus on working in the real-life setting of the client and his family . To evaluate the effectiveness of community care , patients about to be hospitalized were r and omly assigned to a psychiatric hospital or to community alternative treatment .  Outcome measures at discharge and at follow-up completed by the client himself , treatment staff , and family members indicate that  community treatment was more effective than psychiatric hospitalization In a prospect i ve study the criteria and characteristics associated with the admission of acutely ill psychiatric patients to in-patient or day hospital care  were examined . Over a four-month period , 54 patients were admitted to hospital and 43 to a day hospital .  There was significantly more  schizophrenics  in the hospital . Day hospital patients were significantly younger , had shorter psychiatric histories , were considered less severely ill and had more insight into their illness . Hospital patients had poorer employment histories , and perceived their families as less supportive ; admission had more often been requested by them or their families OBJECTIVE Because previous studies of day treatment as an alternative to inpatient treatment had major disadvantages or method ological shortcomings , the authors conducted a r and omized controlled trial to estimate and predict the extent to which day treatment is feasible for unselected patients referred for inpatient treatment . METHOD Of 160 patients , 57 were r and omly assigned to the control condition and 103 were assigned to the experimental condition . Control patients received st and ard clinical care .  In the experimental condition , day treatment was attempted as soon as the patient 's condition permitted . The average number of 
    Output:
    
At present non-r and omised comparative studies give conflicting messages about the roles provided by day centres and the clinical and social needs they are able to meet .
It is therefore probably best that people with serious mental illness and their carers , if given the choice , take a pragmatic decision on which type of unit best meets their needs .