***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 All community-living older adults might benefit from integrated care , but evidence is lacking on the effectiveness of such services for perceived quality of care . Objective To examine the impact of Embrace , a community-based integrated primary care service , on perceived quality of care . Design Stratified r and omized controlled trial . Participants Integrated care and support according to the “ Embrace ” model was provided by 15 general practitioners in the Netherl and s. Based on self-reported levels of case complexity and frailty , a total of 1456 community-living older adults were stratified into non-disease-specific risk profiles ( “ Robust , ” “ Frail , ” and “ Complex care needs ” ) , and r and omized to Embrace or control groups . InterventionEmbrace provides integrated , person-centered primary care and support to all older adults living in the community , with intensity of care dependent on risk profile . Measurements Primary outcome was quality of care as reported by older adults on the Patient Assessment of Integrated Elderly Care ( PAIEC ) . Effects were assessed using mixed model techniques for the total sample and per risk profile . Professionals ’ perceived level of implementation of integrated care was evaluated within the Embrace condition using the Assessment of Integrated Elderly Care . Key results Older adults in the Embrace group reported a higher level of perceived quality of care than those in the control group ( B = 0.33 , 95 % CI = 0.15 - 0.51 , ES d = 0.19 ) . The advantages of Embrace were most evident in the “ Frail ” and “ Complex care needs ” risk profiles . We found no significant advantages for the “ Robust ” risk profile . Participating professionals reported a significant increase in the perceived level of implementation of integrated care ( ES r = 0.71 ) . Conclusions This study shows that providing a population -based integrated care service to community-living older adults improved the quality of care as perceived by older adults and participating professionals INTRODUCTION Prolonged stay in acute hospitals increases the risk of hospital-acquired infections in older patients , and disrupts patient flow and access to care due to bed shortages . We aim ed to investigate the factors associated with  prolonged length of stay ( pLOS ) among older patients ( aged ≥ 78 years ) in a tertiary hospital , to identify the potentially modifiable risk factors that could direct interventions to reduce length of stay ( LOS ) . METHODS During a three-month period from January 2013 to March 2013 , we identified 72 patients with pLOS ( LOS ≥ 21 days ) and compared their demographic and clinical variables with that of 281 r and omly selected control patients ( LOS < 21 days ) using univariate and multivariate logistic regression analyses . RESULTS The mean age of the patients was 85.30 ± 5.34 years ; 54 % of them were female and 72 % were of Chinese ethnicity . Logistic regression revealed the following significant factors for increased LOS : discharge to intermediate and long-term care services ( odds ratio [ OR ] 9.22 , 95 % confidence interval [ CI ] 3.56 - 23.89 ; p < 0.001 ) ; increased severity of illness ( OR 2.41 , 95 % CI 1.12 - 5.21 ; p = 0.025 ) ; and presence of caregiver stress ( OR 3.85 , 95 % CI 1.67 - 8.91 ; p = 0.002 ) . CONCLUSION Presence of caregiver stress and nursing home placement are potential modifiable risk factors of pLOS among older patients . Early identification and management of caregiver stress , as well as expediting discharge planning , may help to reduce the length of stay for this cohort Background Care of frail and dependent older adults with multiple chronic conditions is a major challenge for health care systems . The study objective was to test the efficacy of providing integrated care at home to reduce unnecessary hospitalizations , emergency room visits , institutionalization , and mortality in community dwelling frail and dependent older adults . Methods A prospect i ve controlled trial was conducted , in real-life clinical practice setting s , in a suburban region in Geneva , Switzerl and , served by two home visiting nursing service centers . Three hundred and one community-dwelling frail and dependent people over 60 years old were allocated to previously r and omized nursing teams into Control ( N = 179 ) and Intervention ( N = 122 ) groups :  Controls received usual care by their primary care physician and home visiting nursing services , the Intervention group received an additional home evaluation by a community geriatrics unit with access to a call service and coordinated follow-up . Recruitment began in July 2009 , goals were obtained in July 2012 , and outcomes assessed until December 2012 . Length of follow-up ranged from 5 to 41 months ( mean 16.3 ) . Primary outcome measure was the number of hospitalizations . Secondary outcomes were reasons for hospitalizations , the number and reason of emergency room visits , institutionalization , death , and place of death . Results The number of hospitalizations did not differ between groups however , the intervention led to lower cumulative incidence for the first hospitalization after the first year of follow-up ( 69.8 % , CI 59.9 to 79.6 versus 87 · 6 % , CI 78 · 2 to 97 · 0 ; p = .01 ) . Secondary outcomes showed that the intervention compared to the control group had less frequent unnecessary hospitalizations ( 4.1 % versus 11.7 % , p = .03 ) , lower cumulative incidence for the first emergency room visit , 8.3 % , CI 2.6 to 13.9 versus 23.2 % , CI 13.1 to 33.3 ; p = .01 ) , and death occurred more frequently at home ( 44.4 versus 14.7 % ; p = .04 ) . No significant differences were found for institutionalization and mortality . Conclusions Integrated care that included a home visiting multidisciplinary geriatric team significantly reduced unnecessary hospitalizations , emergency room visits and allowed more patients to die at home . It is an effective tool to improve coordination and access to care for frail and dependent older adults . Trial registration Clinical Trials.gov Identifier : NCT02084108 . Retrospectively registered on March 10th 2014 BACKGROUND Care for elderly persons with disabilities is usually characterized by fragmentation , often leading to more intrusive and expensive forms of care such as hospitalization and institutionalization . There has been increasing interest in the ability of integrated models to improve health , satisfaction , and service utilization outcomes . METHODS A program of integrated care for vulnerable community-dwelling elderly persons ( SIPA [ French acronym for System of Integrated Care for Older Persons ] )  was compared to usual care with a r and omized control trial . SIPA offered community-based care with local agencies responsible for the full range and coordination of community and institutional ( acute and long-term ) health and social services . Primary outcomes were utilization and public costs of institutional and community care . Secondary outcomes included health status , satisfaction with care , caregiver burden , and out-of-pocket expenses . RESULTS Accessibility was increased for health and social home care with increased intensification of home health care . There was a 50 % reduction in hospital alternate level inpatient stays ( " bed blockers " ) but no significant differences in utilization and costs of emergency department , hospital acute inpatient , and nursing home stays . For all study participants , average community costs per person were C dollar 3390 higher in the SIPA group but institutional costs were C dollar 3770 lower with , as hypothesized , no difference in total overall costs per person in the two groups . Satisfaction was increased for SIPA caregivers with no increase in caregiver burden or out-of-pocket costs . As expected , there was no difference in health outcomes . CONCLUSIONS Integrated systems appear to be feasible and have the potential to reduce hospital and nursing home utilization without increasing costs Background With emerging global payment structures , medical systems need to underst and longer-term impacts of care transition strategies . Objective To determine the effect of a care transition program using patient navigators ( PNs ) on health service utilization among high-risk safety-net patients over a 180-day period . Design R and omized controlled trial conducted October 2011 through April 2013 . Participants Patients admitted to the general medicine service with ≥1 readmission risk factor : ( 1 ) age ≥ 60 ; ( 2 ) in-network inpatient admission within prior 6 months ; ( 3 ) index length of stay ≥ 3 days ; or ( 4 ) admission diagnosis of heart failure or ( 5 ) chronic obstructive pulmonary disease . The analytic sample included 739 intervention patients , 1182 controls .  Interventions Through hospital visits and 30 days of post-discharge telephone outreach , PNs provided coaching and assistance with medications , appointments , transportation , communication with primary care , and self-care . Main Measures Primary outcomes : ( 1 ) hospital-based utilization , a composite of ED visits and hospital admissions ; ( 2 ) hospital admissions ; ( 3 ) ED visits ; and ( 4 ) outpatient visits . We evaluated outcomes following an index discharge , stratified by patient age ( ≥ 60 and < 60 years ) , using a 180-day time frame divided into six 30-day periods . Key Results The PN program produced starkly different outcomes by patient age . Among older PN patients  , hospital-based utilization was consistently lower than controls , producing an 18.7 % cumulative decrease at 180 days ( p = 0.038 ) ; outpatient visits increased in the critical first 30-day period ( p = 0.006 ) . Among younger PN patients  , hospital-based utilization was 31.7 % ( p = 0.038 ) higher at 180 days , largely reflecting sharply higher utilization in the initial 30 days ( p = 0.002 ) , with non-significant changes thereafter ; outpatient visits experienced no significant changes . Conclusions A PN program serving high-risk safety-net patients differentially impacted patients based on age , and among younger patients , outcomes varied over time . Our findings highlight the importance for future research to evaluate care transition programs among different sub population s and over longer time periods Background : older people often experience complex problems . Because of multiple problems , care for older people in general practice needs to shift from a ‘ problem-based , disease-oriented ’ care aim ing at improvement of outcomes per disease to a ‘ goal -oriented care ’ , aim ing at improvement of functioning and personal quality of life , integrating all healthcare providers . Feasibility and cost-effectiveness of this proactive and integrated way of working are not yet established . Design : cluster r and omised trial . Participants : all persons aged ≥75 in 59 general practice s ( 30 intervention , 29 control ) , with a combination of problems , as identified with a structured postal question naire with 21 questions on four health domains . Intervention : for participants with problems on ≥3 domains , general practitioners ( GPs ) made an integrated care plan using a functional geriatric approach . Control practice s : care as usual . Outcome measures : ( i ) quality of life ( QoL ) , ( ii ) activities of daily living , ( iii ) satisfaction with delivered health care and ( iv ) cost-effectiveness of the intervention at 1-year follow-up . Trial registration : Netherl and s trial register , NTR1946 . Results : of the 11,476 registered eligible older persons , 7,285 ( 63 % ) participated in the screening . One thous and nine hundred and twenty-one ( 26 % ) had problems on ≥3 health domains . For 225 r and omly chosen persons , a care plan was made . No beneficial effects were found on QoL , patients ' functioning or healthcare use/costs . GPs experienced better overview of the care and stability , e.g. less unexpected dem and s , in the care . Conclusions : GPs prefer proactive integrated care . ‘ Horizontal ’ care using care plans for older people with complex problems can be a valuable tool in general practice . However , no direct beneficial effect was found for older persons Abstract Objective : To evaluate the impact of a programme of integrated social and medical care among frail elderly people living in the community . Design : R and omised study with 1 year follow up . Setting : Town in northern Italy ( Rovereto ) . Subjects : 200 older people already receiving conventional community care services . Intervention : R and om allocation to an intervention group receiving integrated social and medical care and case management or to a control group receiving conventional care . Main outcome measures : Admission to an institution , use and costs of health services , variations in functional status . Results : Survival analysis showed that admission to hospital or nursing home in the intervention group occurred later and was less common than in controls ( hazard ratio 0.69 ; 95 % confidence interval 0.53 to 0.91 ) . Health services were used to the same extent , but control subjects received more frequent home visits by general practitioners . In the intervention group the estimated financial savings were in the order of £ 1125 ( $ 1800 ) per year of follow up . The intervention group had improved physical function ( activities of daily living score improved by 5.1 % v 13.0 % loss in controls ; P<0.001 ) . Decline of cognitive status ( measured by the short portable mental status question naire ) was also reduced ( 3.8 % v 9.4 % ; P<0.05 ) . Conclusion : Integrated social and medical care with case management programmes may provide a cost effective approach to reduce admission to institutions and functional decline in older people living in the community . Key messages Responsibility for management of care of elderly people living in the community is poorly defined Integration of medical and social services together with care management programmes would improve such care in the community In a comparison of this option with a traditional and fragmented model of community care the integrated care approach reduced admission to institutions and functional decline in frail elderly people living in the community and also reduced OBJECTIVES To evaluate the impact of 
    Output:
    
Findings show that integrated care tends to have a positive impact on hospital admission rates , some positive impact on length of stay and possibly also on readmission and patient satisfaction but not on mortality .
Conclusions Integrated care may reduce hospital admission rates and lengths of hospital stay .
However due to lack of robust findings , the effectiveness of integrated care on patient-related outcomes in later life remain largely unknown .