***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: OBJECTIVES To study the feasibility and effectiveness of a  discharge planning intervention . DESIGN Quasi-experimental pre-post study design . SETTING General medicine wards at three hospitals : an academic medical center , a community teaching hospital , and a community-based nonteaching hospital . PARTICIPANTS All patients aged 65 and older admitted to the hospitalist services . INTERVENTION The intervention toolkit had five core elements : admission form with geriatric cues , facsimile to the primary care provider , interdisciplinary worksheet to identify barriers to discharge , pharmacist-physician collaborative medication reconciliation , and predischarge planning appointments . MEASUREMENTS Thirty-day readmission and return to emergency department rates and patient satisfaction with discharge . Odds ratios were determined , and site effects were examined accordig to interaction terms and Breslow Day statistics . RESULTS Two hundred thirty-seven patients were followed during the preintervention period , and 185 were exposed to the intervention . Patients characteristics were similar across the two time periods . The proportion of patients with high- quality transitions home , measured according to Coleman 's Care Transition Measures , increased from 68 % to 89 % ( odds ratio (OR)=3.49 , 95 % confidence interval (CI)=2.06 - 5.92 ) . Return to the emergency department within 3 days of discharge was lower in the intervention period ( 10 % vs 3 % , OR=0.25 , 95 % CI=0.10 - 0.62 ) . At 30 days , there was a lower rate of readmission ( 22 % vs 14 % , OR=0.59 , 95 % CI=0.34 - 0.97 ) and fewer visits to the emergency department ( 21 % vs 14 % , OR=0.61 , 95 % CI=0.36 - 1.03 ) ( P=.06 ) . CONCLUSION When hospitalized elderly patients are treated with consideration of their specific needs , healthcare outcomes can be improved OBJECTIVES To compare the effects of community hospital care on independence for older people needing rehabilitation  with that of general hospital care . DESIGN R and omized , controlled trial . SETTING Seven community hospitals and five general hospitals in the midl and s and north of Engl and . PARTICIPANTS Four hundred ninety patients needing rehabilitation after hospital admission with an acute illness . INTERVENTION Multidisciplinary team care for older people in community hospitals . MEASUREMENTS The primary outcome was the Nottingham extended activities of daily living scale ( NEADL ) ; secondary outcomes were the Barthel Index , Nottingham Health Profile , Hospital Anxiety and Depression Scale , mortality , discharge destination , 6-month residence status , and satisfaction with services . RESULTS Loss of independence at 6 months was significantly less likely in the community hospital group ( mean adjusted NEADL change score group difference 3.27 ; 95 % confidence interval 0.26 - 6.28 ; P=.03 ) . The results for the secondary outcome measures were similar for the two groups . CONCLUSION Postacute community hospital rehabilitation care for older people is associated with greater independence Abstract Most older adults are admitted to home health care with some functional impairment related to chronic illness and /or hospitalization . This article describes : ( 1 ) the impact of a quality improvement initiative ( QI ) on functional outcomes of older , chronically ill patients served by a large homecare organization ; and ( 2 ) key implementation challenges affecting intervention outcomes . Over 6,000 patients were included in two dissemination phases . Phase 1 r and omly assigned service delivery teams to intervention ( QI ) or usual care ( UC ) . Phase 2 spread the intervention to UC teams . Phase 1 yielded statistically significant , albeit modest , functional improvements among intervention team patients relative to UC . Phase 2 improvements in the original intervention group were smaller , suggesting some regression to the mean . UC teams did not “ catch up ” when exposed to the intervention in Phase 2 . Analysis of the implementation process suggested that modification of improvement strategies and “ dilution ” of peer‐to‐peer communication hindered additional Phase 2 improvements . The findings highlight the challenges of relying on peer‐to‐peer spread , and of distinguishing the core elements of an effective improvement strategy that must be spread consistently from those that can be adapted to variations within and across organizations BACKGROUND The pharmaceutical care approach serves as a model for medication review , involving collaboration between GPs , pharmacists , patients , and carers . Its use is advocated with older patients who are typically prescribed several drugs . However , it has yet to be thoroughly evaluated . AIM To estimate the effectiveness of pharmaceutical care for older people , shared between GPs and community pharmacists in the UK , relative to usual care . DESIGN OF STUDY Multiple interrupted time-series design in five primary care trusts which implemented pharmaceutical care at 2-month intervals in r and om order . Patients acted as their own controls , and were followed over 3 years including their 12 months ' participation in pharmaceutical care . SETTING In 2002 , 760 patients , aged > or = 75 years , were recruited from 24 general practice s in East and North Yorkshire . Sixty-two community pharmacies also took part . A total of 551 participants completed the study . METHOD Pharmaceutical care was undertaken by community pharmacists who interviewed patients , developed and implemented pharmaceutical care plans together with patients ' GPs , and thereafter undertook monthly medication review s. Pharmacists and GPs attended training before the intervention . Outcome measures were the UK Medication Appropriateness Index , the Short Form-36 Health Survey ( SF-36 ) , and serious adverse events . RESULTS The intervention did not lead to any statistically significant change in the appropriateness of prescribing or health outcomes . Although the mental component of the SF-36 decreased as study participants become older , this trend was not affected by pharmaceutical care . CONCLUSION The RESPECT model of pharmaceutical care ( R and omised Evaluation of Shared Prescribing for Elderly people in the Community over Time ) shared between community pharmacists and GPs did not significantly change the appropriateness of prescribing or quality of life in older patients OBJECTIVES To determine whether a multidisciplinary team intervention minimizes unanticipated transitions from assisted living for persons with dementia . DESIGN R and omized trial . SETTING Two dementia-specific assisted living facilities in Connecticut owned and managed by the same corporation . PARTICIPANTS One hundred older adults with dementia who relocated to assisted living . INTERVENTION Four systematic multidisciplinary assessment s by a geriatrician , geriatrics advanced practice nurse , physical therapist , dietitian , and social worker during the first 9 months of relocation to assisted living . MEASUREMENTS Permanent relocation to a nursing facility , emergency department ( ED ) visits , hospitalization , and death . RESULTS Fifty-five residents experienced any unanticipated transition out of assisted living , on average 84 + /- 74 days after relocation ; falls were the primary reason for transition . The intervention reduced the risk of any unanticipated transitions ( 13 % ) , permanent relocation to a nursing facility ( 11 % ) , ED visits ( 12 % ) , hospitalization ( 45 % ) , and death ( 63 % ) , but the results did not meet statistical significance . In secondary analysis , more men experienced any unanticipated transition ( P<.001 ) , hospitalization ( P<.001 ) , or death ( P<.001 ) than women . CONCLUSION Although an untargeted multidisciplinary intervention did not significantly reduce the risk of transitions for individuals with dementia relocating to assisted living in this small sample , trends for decreasing hospitalization and death were found . The data further suggest that those at risk for falls and men may benefit from targeted clinical interventions to prevent unanticipated transitions , especially during the first 3 months after relocation 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 determine the long-term effects on total healthcare costs of the Improving Mood : Promoting Access to Collaborative Treatment ( IMPACT ) program for late-life depression compared with usual care . STUDY DESIGN R and omized controlled trial with enrollment from July 1999 through August 2001 . The IMPACT trial , conducted in primary care practice s in 8 delivery organizations across the United States , enrolled 1801 depressed primary care patients 60 years or older . Data are from the 2 IMPACT sites for which 4-year cost data were available . Trial enrollment across these 2 health maintenance organizations was 551 patients . METHODS Participants were r and omly assigned to the  IMPACT intervention  ( n = 279 ) or to  usual primary care ( n = 272 ) . Intervention patients had access to a depression care manager who provided education , behavioral activation , support of antidepressant medication management prescribed by their regular primary care provider , and problem-solving treatment in primary care for up to 12 months . Care managers were supervised by a psychiatrist and a primary care provider . The main outcome measures were healthcare costs during 4 years . RESULTS  IMPACT participants had lower mean total healthcare costs ( $ 29 422 ; 95 % confidence interval , $ 26 479-$32 365 ) than usual care patients ( $ 32 785 ; 95 % confidence interval , $ 27 648-$37 921 ) during 4 years . Results of a bootstrap analysis suggested an 87 % probability that the IMPACT program was associated with lower healthcare costs than usual care . CONCLUSION Compared with usual primary care , the IMPACT program is associated with a high probability of lower total healthcare costs during a 4-year period 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 
    Output:
    
DISCUSSION AND CONCLUSION The overall effects of interprofessional interventions for elderly are positive , but based on heterogeneous outcomes .
For ' collaboration ' the outcome indicators are key elements of collaboration , involved disciplines , professional and patient satisfaction and quality of care .