***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: This paper evaluates the Post-Hospital Support Program for the frail elderly and their caregivers using a quasi-experimental design . The program goals were to reduce stress in the caregivers , improve functioning and reduce mortality in patients , and reduce health service utilization in patients . Subjects were patients at the Johns Hopkins Hospital in Baltimore , Maryl and , age 65 or over , who were returning home to the care of a non-paid caregiver and who had extensive post-hospital care needs which were expected to continue for at least one year . The 93 comparison group patient/caregiver pairs were discharged between May 15 , 1983 and May 14 , 1984 . The 98 treatment group pairs were discharged between May 15 , 1984 and May 14 , 1985 . Interviews were conducted with patients and caregivers at 1 , 3 , 6 , 9 , and 12 months after discharge . Results showed a slight reduction in caregiver stress and a substantial reduction in hospital days used by the treatment group . When confounding and history effects are taken into consideration , an average difference of 6.5 days per patients remains . The data also suggest that the treatment program may have postponed some deaths and nursing home placements . The results suggest that support services for the frail elderly and their caregivers can be cost efficient by reducing hospital length-of-stay . Savings were estimated at $ 4,585 per patient per year in this study . However , further work is needed to design programs which more effectively reduce caregiver stress A r and om sample of 133 elderly patients who had an unplanned readmission to a district general hospital within 28 days of discharge from hospital was studied and compared with a matched control sample of patients who were not readmitted .  The total group was drawn from all specialties in the hospital , and by interviewing the patients , their carers , the ward sisters , and the patients ' general practitioners the factors causing early unplanned readmission for each patient were identified . Seven possible principal reasons were found : relapse of original condition , development of a new problem , carer problems , complications of the initial illness , need for terminal care , problems with medication , and problems with services . There were also contributory reasons , and it was usual for several of these to be present in each case . The unplanned readmission rate was 6 % ; the planned readmission rate was 3 % . It was thought that unplanned readmission was avoidable for 78 ( 59 % ) patients . Patients in the study group and in the control group showed significant differences in certain characteristics -- such as low income , previous hospital admission , already having nursing care , and admission by general practitioners-- and this might help to identify patients who are likely to be readmitted in an emergency The aim of this prospect i ve , r and omized and controlled trial was to carry out and evaluate a model for follow-up by home visits after discharge from hospital of persons aged 75 years or more . The trial was a feasibility study in which hospital staff , district nurses , and general practitioners already working within the hospital and the primary health sector participated , with changes in the usual organization . On the day after their discharge from hospital , 163 patients were visited in their homes by the district nurse .  Two weeks later , they were evaluated at home by their general practitioner . For 181 control patients , discharge took place according to the usual procedures . Endpoints were evaluated one year after discharge . Significantly more patients from the control group had been admitted to nursing homes as compared with the trial group ( 25/10 , p < 0.05 ) ; the control patients stayed 2700 days at institutions , the trial group 1950 days . It is proposed that this simple and practicable follow-up routine be introduced in connection with discharge of elderly persons from hospital This paper reports the results of a retrospective review which analysed  emergency admissions and readmissions of elderly patients to a district general hospital . All patients received st and ard after-care allocated by the community health and social services departments following referral by hospital staff . In addition , half of the cohort was r and omly allocated to receive care attendant support for a maximum of 12 hours a week for two weeks following the first and any subsequent discharge from hospital . The effect of this additional community support on emergency readmissions was also review ed . The findings show that the patients r and omly allocated to receive the modest domiciliary after-care service were less likely to have another emergency readmission or multiple readmissions . The results suggest that patients over 75 years-of-age , living alone , or having two or more emergency admissions within six months , should have a domiciliary assessment and follow-up after hospital discharge PURPOSE Pulmonary rehabilitation programs often show beneficial effects in patients with chronic obstructive pulmonary disease ( COPD ) . These programs are usually hospital-based . This study assesses the feasibility and application of a 12-week Home-Care Rehabilitation Program ( HCRP ) , carried out by general practitioners , physiotherapists , and home-care nurses . METHODS Effects of the HCRP are assessed in 15 COPD patients with moderate to severe airflow limitation ( inspiratory vital capacity [ IVC ] : mean , 75.4 [ SD , 13.7 ] percent predicted , mean FEV1 : 45.5 [ 6.9 ] percent predicted ) and are compared with a stratified and r and omized control group ( n = 15 ) . RESULTS All participating disciplines judged the program to be useful and feasible . Patient compliance with the rehabilitation exercises was high . No major problems concerning the rehabilitation program were reported . After the HCRP , 4-minute walking distance improved significantly from 274 m [ 61 ] to 301 m [ 72 ] and maximal work load ( W max ) , as measured during an incremental cycle test , increased from 75.3 W [ 24 ] to 85.3 W [ 28 ] . At equal work levels ( W submax ) during the cycle test both Borg dyspnea and leg effort scores decreased significantly after the HCRP ( 6.7 [ 1.3 ] versus 4.9 [ 1.7 ] and 4.2 [ 2.0 ] versus 1.7 [ 2.5 ] , respectively ) . Changes in walking distance , dyspnea , and leg effort scores at W submax were significantly different between the two groups . IVC and FEV1 did not change significantly . In the control group , no significant changes in any parameter were observed . CONCLUSION It was possible to design and perform successfully a home-care rehabilitation program , providing both objective and subjective improvements in a group of patients with COPD . A home-care rehabilitation program appears to be a valuable component in the management of COPD patients with a moderate to severe airflow limitation OBJECTIVE To study the effects of a comprehensive discharge planning protocol , design ed specifically for the elderly and implemented by nurse specialists , on  patient and caregiver outcomes and cost of care . DESIGN R and omized clinical trial . SETTING Hospital of the University of Pennsylvania . PATIENTS 276 patients and 125 caregivers . Patients were 70 years and older and were placed in selected medical and surgical cardiac diagnostic-related groups . MEASUREMENTS Group differences in patient outcomes ( length of initial hospital stay , length of time between initial hospital discharge and readmission , and rehospitalization rates ) and charges for care ( charges for initial hospitalization , rehospitalizations , health services after discharge , and nurse specialist services ) were measured 2 , 6 , and 12 weeks after discharge . RESULTS From the initial hospital discharge to 6 weeks after discharge , patients in the medical intervention group had fewer readmissions , fewer total days rehospitalized , lower readmission charges , and lower charges for health care services after discharge . No differences in these outcomes were found between the surgical intervention and control groups during this period . CONCLUSIONS Study findings support the need for comprehensive discharge planning design ed for the elderly and implemented by nurse specialists to improve their outcomes after hospital discharge and to achieve cost savings . The findings also suggest that this intervention had its greatest effect in delaying or preventing rehospitalization of patients in the medical intervention group during the first 6 weeks after discharge Elderly people discharged directly home from an accident and emergency department are known to be a vulnerable group . The value of health visitor follow-up in patients aged 75 years and over was assessed in a r and om controlled trail ; 222 intervention patients were seen at home by a research health visitor shortly after discharge and screened for new dependency and support needs , appropriate community services then being offered . These patients , and 192 controls for whom no special arrangements were made , were followed up four weeks later by a research occupational therapist .  New dependency , most commonly trauma-related , was found in approximately 50 % , and in the majority proved transient . Advice and /or referral to a wide range of services was offered to 92 % of the intervention group . Service refusal rates were high in both groups . Compared to controls , intervention patients received more services and were significantly more independent at four weeks . Health visitor assessment was seen as helpful . In order to identify elderly accident and emergency department patients at risk following discharge , study data were used to derive a short question naire . In follow-up visits to 48 patients the use of this question naire was piloted , and its validity demonstrated . A number of study limitations and areas for development of discharge planning are discussed OBJECTIVE To determine whether there was any benefit from a single house call by a health visitor ( a public health nurse ) to an elderly person after discharge home from a geriatric hospital . METHODS A r and omized controlled trial with blind assessment s at 28 days was conducted . Subjects included residents of Bath , Engl and , with an average age of 83 years , who were discharged consecutively from a geriatric hospital to their homes . Intervention was a single visit by a health visitor 72 hours after discharge , to ensure the patient was settled at home , or normal post-discharge care . Outcome measures taken at 28 days by a research nurse included survival , hospital readmissions , nursing home admissions , cognitive and physical function , services requested and supplied , and drug therapy . RESULTS There were no important differences between the intervention and control groups at 28 days on any of the outcome measurements . The control subjects did better than the study subjects on many of the outcome measures . CONCLUSION A house call by a health visitor to elderly patients after discharge from geriatric wards does not measurably improve the quality of the discharge BACKGROUND The diffusion of comprehensive geriatric assessment services has been rather limited in North America partly because of reimbursement and organizational constraints . OBJECTIVE To evaluate the impact of a comprehensive geriatric assessment intervention for frail older patients that is started before hospital discharge and is continued at home . METHODS Patients older than 65 years were selected who had either unstable medical problems , recent functional limitations , or potentially reversible geriatric clinical problems . Patients ( n = 354 ) were r and omly assigned to either the intervention group or a control group . Information on survival , readmissions , nursing home placement , medication use , and health status was collected at 30 and 60 days after hospital discharge . RESULTS No differences were observed between the two treatment groups in survival , hospital readmission , or nursing home placement by 60 days . After adjustment for baseline characteristics , no significant differences were observed between the two groups on measures of physical functioning , social functioning , role limitations , health perceptions , pain , mental health , energy and /or fatigue , health change , or overall well-being . CONCLUSIONS Although efficacy has been demonstrated for some forms of comprehensive geriatric assessment , the types of services that are easier to establish ( inpatient consultation services and ambulatory assessment ) have not been shown to improve outcomes . Our results indicate that outcomes are unaffected by a limited form of comprehensive geriatric assessment begun in the hospital and completed at home . Further efforts are needed to develop and to evaluate realistic approaches to comprehensive geriatric assessment The purpose of this study was to evaluate the impact of a primary home care intervention program on patient outcomes after selected patients were discharged from a short-stay hospital . R and om assignment of 249 frail , elderly patients was made to a group provided with physician-led primary home care , and home assistance service on a 24-hour basis , or to a control group given st and ard care . At r and omization , patients were considerably disabled , had a mean age of 80.5 years , and had a high likelihood of long-stay hospital care .  Medical and functional data were essentially the same at baseline for both groups . At 6-months follow-up , significant improvement in instrumental activities of daily living ( P = 0.04 ) and outdoor walking ( P = 0.03 ) , and medical condition was found in the primary care intervention group compared with the controls and less utilization of long-stay hospital facilities was displayed in the team patients ( P < 0.001 ) than in the controls . A selection of elderly , dependent patients can be cared for in their homes after short-stay hospital discharge and benefit from this primary home care intervention program in terms of improved medical and functional outcomes and less long-stay hospitalization A r and omised controlled trial was conducted to assess whether a single intervention by a health visitor reduced the unplanned re-admission of elderly people discharged from geriatric wards . Two hundred and four consecutive discharges from geriatric wards were r and omly allocated to receive either a single visit from the health visitor at 72 h in addition to normal follow-up services or to a control group receiving the normal follow-up services . The primary outcome measure was the unplanned re-admissions over the following 6 months . There were 40 cases and 43 control patients with unplanned re-admissions in the first 6 months . The total lengths of the unplanned re-admissions were 1237 days for cases and 1427 for controls , an average of 12.1 days for cases and 14.0 for controls ( 95 % confidence interval -4.9 to 8.7 days , not significant ) . A visit by a health visitor to elderly patients after discharge from geriatric wards is unlikely to be of sufficient benefit to the patients for the service to be funded from a saving in unplanned re-admissions This study examined the effects of a primary home care intervention 
    Output:
    
This was associated with a consistent pattern of reduction in admission to long-stay care over the same period , without apparent increases in mortality .
There was uncertainty about the effect of supported discharge on hospitalization .
CONCLUSIONS we believe that the results of this review provide reassurance that supporting discharge from hospital to home is of value .