Other characteristics , including specialist versus generalist provision , did not appreciably impact programme effectiveness .
Conclusions Shorter secondary prevention programmes , those based in general practice , and those staffed by generalists are at least as effective in reducing all cause mortality in patients with coronary heart disease as longer programmes , hospital-based programmes , and programmes staffed by specialists
Background The aim of this study was to determine which programme characteristics influence the effectiveness of secondary prevention programmes for Coronary Heart Disease .
A case manager intervention to reduce readmissions.
BACKGROUND Acute hospitalizations represent substantial financial liability to closed health care systems . Among hospitalized patients , those with repeated admissions are high-cost users . Most managed care plans employ case management to control hospital use . This technique attempts to detect and fulfill unmet medical and social needs , intensify postdischarge care , identify and mobilize effective community services , and enhance primary care access . Despite the popularity of case management to control hospital use , few trials have examined its efficacy . METHODS We conducted a r and omized controlled trial of an intervention of  case managers at a university-affiliated Veterans Affairs medical center . Six hundred sixty-eight patients aged 45 years or older who were discharged from the general medicine inpatient service , who had access to a telephone , and who received primary care at the hospital 's clinics were r and omized to the intervention ( N = 333 ) and control ( N = 335 ) groups . Within 24 hours of discharge , case managers mailed educational material s and access information to intervention patients , and within 5 days they called to review and resolve unmet needs , early warning signs , barriers to keeping appointments , and any readmissions . Case managers contacted intervention patients if they made no visits for 30 days . This result ed in a total of 6260 patient-case manager contacts . Control and intervention patients were followed up for 12 months . RESULTS Intervention patients had more frequent visits per patient per month to the general medicine clinic ( 0.30 + /- 0.23 vs 0.26 + /- 0.22 , P = .008 ) , but we detected no significant differences between groups in nonelective readmissions , readmission days , or total readmissions . CONCLUSIONS Frequent contacts for education , care , and accessibility by case managers using protocol s were ineffective in reducing nonelective readmissions
Other characteristics , including specialist versus generalist provision , did not appreciably impact programme effectiveness .
Conclusions Shorter secondary prevention programmes , those based in general practice , and those staffed by generalists are at least as effective in reducing all cause mortality in patients with coronary heart disease as longer programmes , hospital-based programmes , and programmes staffed by specialists
Background The aim of this study was to determine which programme characteristics influence the effectiveness of secondary prevention programmes for Coronary Heart Disease .