***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 Various healthcare interventions have been launched targeting the growing population of older people . The objective of this study was to investigate the of a case management intervention for frail old people ( aged 65 + years ) effects on healthcare utilization . MATERIAL S AND METHODS The study was conducted in a municipality in southern Sweden and included people aged 65 + years who lived in their ordinary homes , were dependent in two or more activities of daily living ( ADL ) , and had at least two hospital admissions , or four physician visits , in the previous year . One-hundred-fifty-three participants were r and omly assigned to either an intervention ( n=80 ) or a control group ( n=73 ) . The one-year intervention comprised home visits , at least once a month , by case managers . Group differences were investigated 6 - 12 and 0 - 6 months before , and 0 - 6 and 6 - 12 months after , baseline . RESULTS The intervention group had , compared to the control group , significant lower mean number ( 0.08 vs. 0.37 , p=0.041 ) and proportion ( 17.4 vs. 46.9 % , p=0.016 ) of ED visits not leading to hospitalization 6 - 12 months after baseline . The intervention group also had a significantly lower mean number of visits to physicians in outpatient care 6 - 12 months after baseline ( 4.09 vs. 5.29 , p=0.047 ) . CONCLUSION The effect on ED visits not leading to hospitalization meant that those in the control group were more likely to visit the ED for reasons that did not require hospitalization , suggesting that they may have been less monitored than the intervention group . The intervention has the potential to reduce the burden on outpatient care and ED Background This study explored the effectiveness of a pro-active , integrated care model for community-dwelling frail older people compared to care as usual by evaluating the effects on a comprehensive set of outcomes : health outcomes ( experienced health , mental health and social functioning ) ; functional abilities ; and quality of life ( general , health-related and well-being ) . Methods The design of this study was quasi-experimental . In this study , 184 frail older patients of three GP practice s that implemented the Walcheren Integrated Care Model were compared with 193 frail older patients of five GP practice s that provided care as usual .  In the Walcheren Integrated Care Model , community-dwelling elderly were pro-actively screened for frailty from the GP practice using the Groningen Frailty Indicator , and care needs were assessed with the EASYcare instrument . The GP practice functioned as single entry point from which case management was provided , and the GP was the coordinator of care . The entire process was supported by multidisciplinary meetings , multidisciplinary protocol s and web-based patient files . The outcomes of this study were obtained at baseline , after 3 months and after 12 months and analyzed with linear mixed models of repeated measures . Results The Walcheren Integrated Care Model had a positive effect on love and friendship and a moderately positive effect on general quality of life . The ability to receive love and friendship and general quality of life decreased in the control group but was preserved in the experimental group . No significant differences were found on health outcomes such as experienced health , mental health , social functioning and functional abilities . Conclusions The results indicated that pro-active , integrated care can be beneficial for frail older people in terms of quality of life and love and friendship but not in terms of health outcomes and functional abilities . Recommendations for future research are to gain greater insight into what specific outcomes can be achieved with proactive and integrated care , considering the specific content of this care , and to allow for the heterogeneity of frail older people in evaluation research .Trial registration Current Controlled Trials IS RCT N05748494 . Registration date : 14/03/2013 BACKGROUND The aim of this r and omized controlled trial was to determine the effects on functional parameters of an up date d preventive home visit program for frail older adults in the Japanese Long-term Care Insurance ( LTCI ) system . METHODS The program included home visits by nurses or care managers every 3 months for 24 months , with a systematic assessment of care needs to prevent functional decline . Eligible participants ( N = 360 ) were r and omly assigned to the visit ( VG : n = 179 ) or control group ( CG : n = 181 ) .  Functional parameters were gathered via mail question naires at baseline and at 12- and 24-month follow-ups . Care-need levels in the LTCI were obtained at 12- , 24- , and 36-month follow-ups and the utilization of the LTCI service through 36 months . RESULTS Participants in VG were significantly more likely to maintain their activities of daily living ( ADL ) functioning ( p = .0113 ) and less likely to increase care-needs level , compared with CG participants , over 24 months . A generalized linear model showed that the estimate of the effect on increase in care-needs level ( ie , functional decline ) was -0.53 ( p = .042 ) over 36 months . CONCLUSIONS These results suggest that the up date d preventive home visit program could be effective for the prevention of ADL and care-needs deterioration , and these effects could continue up to 1 year after program completion BACKGROUND The effectiveness of community-based geriatric intervention models for vulnerable older adults is controversial . We evaluated a problem-based multidisciplinary intervention targeting vulnerable older adults at home that promised efficacy through better timing and increased commitment of patients and primary care physicians . This study compared the effects of this new model to usual care . METHODS Primary care physicians referred older people for problems with cognition , nutrition , behavior , mood , or mobility . One hundred fifty-one participants ( mean age 82.2 years , 74.8 % women ) were included in a pseudocluster r and omized trial with 6-month follow-up for the primary outcomes . Eighty-five participants received the new intervention , and 66 usual care .  In the intervention arm , geriatric nurses visited patients at home for geriatric assessment and management in cooperation with primary care physicians and geriatricians . Modified intention-to-treat analyses focused on differences between treatment arms in functional abilities ( Groningen Activity Restriction Scale-3 ) and mental well-being ( subscale mental health Medical Outcomes Study [MOS]-20 ) , using a mixed linear model . RESULTS After 3 months , treatment arms showed significant differences in favor of the new intervention .  Functional abilities improved 2.2 points ( 95 % confidence interval [ CI ] , 0.3 - 4.2 ) and well-being 5.8 points ( 95 % CI , 0.1 - 11.4 ) . After 6 months , the favorable effect increased for well-being ( 9.1 ; 95 % CI , 2.4 - 15.9 ) , but the effect on functional abilities was no longer significant ( 1.6 ; 95 % CI , -0.7 to 3.9 ) . CONCLUSIONS This problem-based geriatric intervention improved functional abilities and mental well-being of vulnerable older people . Problem-based interventions can increase the effectiveness of primary care for this population Background Case management has been applied in community aged care to meet frail older people ’s holistic needs and promote cost-effectiveness . This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes . Methods We search ed Web of Science , Scopus , Medline , CINAHL ( EBSCO ) and PsycINFO ( CSA ) from inception to 2011 July . Inclusion criteria were : no restriction on date , English language , community-dwelling older people and /or carers , case management in community aged care , published in refereed journals , r and omized control trials ( RCTs ) or comparative observational studies , examining client or carer outcomes . Quality of studies was assessed by using such indicators as quality control , r and omization , comparability , follow-up rate , dropout , blinding assessors , and intention-to-treat analysis . Two review ers independently screened potentially relevant studies , extracted information and assessed study quality . A narrative summary of findings were presented . Results Ten RCTs and five comparative observational studies were identified . One RCT was rated high quality . Client outcomes included mortality ( 7 studies ) , physical or cognitive functioning ( 6 studies ) , medical conditions ( 2 studies ) , behavioral problems ( 2 studies ) , unmet service needs ( 3 studies ) , psychological health or well-being ( 7 studies ) , and satisfaction with care ( 4 studies ) , while carer outcomes included stress or burden ( 6 studies ) , satisfaction with care ( 2 studies ) , psychological health or well-being ( 5 studies ) , and social consequences ( such as social support and relationships with clients ) ( 2 studies ) . Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group , while all the three studies consistently reported fewer unmet service needs among the intervention participants . In contrast , available studies reported mixed results regarding client physical or cognitive functioning and carer stress or burden . There was also limited evidence indicating significant effects of the interventions on the other client and carer outcomes as described above . Conclusions Available evidence showed that case management in community aged care can improve client psychological health or well-being and unmet service needs . Future studies should investigate what specific components of case management are crucial in improving clients and their carers ’ outcomes AIM The purpose of this study was to test the effectiveness of a collaborative primary care nurse case management intervention emphasising collaboration between physicians , nurses and patients , risk identification , comprehensive assessment , collaborative planning , health monitoring , patient education and transitional care on healthcare utilisation and cost for community dwelling chronically ill older persons . BACKGROUND Primary care teams comprised of nurses and primary care physicians have been suggested as a model for providing quality care to the chronically ill , but this type of intervention has not been systematic ally evaluated . DESIGN A non-r and omised , 36 month comparison of two geographically distinct primary care population s was conducted . METHODS Six hundred and seventy-seven persons aged 65 and older were determined to be at high-risk for mortality , functional decline , or increased health service use . The treatment group ( n = 400 ) received  the intervention  and the  comparison group ( n = 277 ) received usual care . Health plan cl aims files provided data on number of hospitalisations and bed days , emergency department ( ED ) visits , physician visits and total cost of care . RESULTS After adjustment for baseline variables , there were no significant differences between the treatment and comparison group in the percentage of patients hospitalised or ED visits . However , among those hospitalised in the treatment group , the likelihood of being re-hospitalised was significantly reduced by 34 % ( p = 0·032 ) . After adjusting for the cost of the intervention , although not statistically significant , the reduced hospital use result ed in cost savings of $ 106 per patient per month in the treatment group . CONCLUSIONS The results indicate that a collaborative primary care nurse case management intervention has the potential to be an effective alternative to current primary care delivery system practice . RELEVANCE TO CLINICAL PRACTICE The study suggests that a chronic care intervention emphasising collaboration between physicians , nurses and patients , may be more effective when implemented in integrated provider networks The purpose of this study was to evaluate high-risk older adults ' satisfaction with outpatient  geriatric evaluation and management ( GEM ) .  Community-dwelling Medicare beneficiaries ( n = 522 ) age 70 years and older who had a high probability of repeated admission to hospitals ( Pra > .40 ) were r and omly assigned to receive either  usual care or GEM  for six months . Despite the stresses imposed by outpatient GEM ( e.g. , new relationships with providers , frequent office visits and changes in treatments ) , the mean satisfaction scores of the recipients of GEM were 9 % higher than those of the recipients of usual care ( 4.31 vs 3.96 , p < .001 ) . The primary physicians of GEM recipients were also highly satisfied with GEM care Objective To evaluate whether an interdisciplinary primary care approach for community dwelling frail older people is more effective than usual care in reducing disability and preventing ( further ) functional decline . Design Cluster r and omised controlled trial . Setting 12 general practice s in the south of the Netherl and s Participants 346 frail older people ( score ≥5 on Groningen Frailty Indicator ) were included ; 270 ( 78 % ) completed the study . Interventions General practice s were r and omised to the intervention or control group . Practice s in the control group delivered care as usual . Practice s in the intervention group implemented the “ Prevention of Care ” ( PoC ) approach , in which frail older people received a multidimensional assessment and interdisciplinary care based on a tailor made treatment plan and regular evaluation and follow-up . Main outcome measures The primary outcome was disability , assessed at 24 months by means of the Groningen Activity Restriction Scale . Secondary outcomes were depressive symptomatology , social support interactions , fear of falling , and social participation . Outcomes were measured at baseline and at 6 , 12 , and 24 months ’ follow-up . Results 193 older people in the intervention group ( six practice s ) received the PoC approach ; 153 older people in the control group ( six practice s ) received care as usual  . Follow-up rates for patients were 91 % ( n=316 ) at six months , 86 % ( n=298 ) at 12 months , and 78 % ( n=270 ) at 24 months . Mixed model multilevel analyses showed no significant differences between the two groups with regard to disability ( primary outcome ) and secondary outcomes . Pre-planned subgroup analyses confirmed these results . Conclusions This study found no evidence for the effectiveness of the PoC approach . The study contributes to the emerging body of evidence that community based care in frail older people is a challenging task . More research in this field is needed . Trial registration Current 
    Output:
    
Our systematic review reveals that the majority of the reported outcomes in the studies on preventive , integrated care show no effects .
In terms of health outcomes , effectiveness is demonstrated most often for seldom-reported outcomes such as well-being .
Outcomes regarding informal caregivers and professionals are rarely considered and negligible .
Most promising are the care process outcomes that did improve for preventive , integrated care interventions as compared to usual care .
Healthcare utilisation was the most reported outcome but we found mixed results .