FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 334:1441-1447 May 30, 1996 Number 22 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background For chronically ill patients, readmission to the hospital can be frequent and costly. We studied the effect of an intervention designed to increase access to primary care after discharge from the hospital, with the goals of reducing readmissions and emergency department visits and increasing patients' quality of life and satisfaction with care.

Methods In a multicenter randomized, controlled trial at nine Veterans Affairs Medical Centers, we randomly assigned 1396 veterans hospitalized with diabetes, chronic obstructive pulmonary disease, or congestive heart failure to receive either usual care or an intensive primary care intervention. The intervention involved close follow-up by a nurse and a primary care physician, beginning before discharge and continuing for the next six months.

Results The patients were severely ill. Half of those with congestive heart failure (504 patients) had disease in New York Heart Association class III or IV; 30 percent of those with diabetes (751 patients) had end-organ damage; and a quarter of those with chronic obstructive pulmonary disease (583 patients) required home oxygen treatment or oral corticosteroids. The patients had extremely poor quality-of-life scores. Although they received more intensive primary care than the controls, the patients in the intervention group had significantly higher rates of readmission (0.19 vs. 0.14 per month, P = 0.005) and more days of rehospitalization (10.2 vs. 8.8, P = 0.041). The patients in the intervention group were more satisfied with their care (P<0.001), but there was no difference between the study groups in quality-of-life scores, which remained very low (P = 0.53).

Conclusions For veterans discharged from Veterans Affairs hospitals, the primary care intervention we studied increased rather than decreased the rate of rehospitalization, although patients in the intervention group were more satisfied with their care.

Source Information

From the Richard L. Roudebush Veterans Affairs Medical Center (VAMC), Indianapolis (M.W.); the Center for Health Services Research in Primary Care, Durham VAMC, Durham, N.C. (E.Z.O.); and the Center for Cooperative Studies in Health Services, Hines VAMC, Hines, Ill. (W.G.H.).

Address reprint requests to Dr. Weinberger at Health Services Research and Development (11H), Richard L. Roudebush VAMC, 1481 W. Tenth St., Indianapolis, IN 46202.

Full Text of this Article

Related Letters:

A Trial of Increased Access to Primary Care
Henley D. E., Starfield B., Parrino T. A., Snider G. L., Colucci W. S., Sawin C. T., Magill M. K., Babitz M., Silver M. P., Rich M. W., Corey G. A., Burack J. H., Portnoi V. A., Adams W. L., Weinberger M., Oddone E. Z., Henderson W. G., Welch H. G.
Extract | Full Text  
N Engl J Med 1996; 335:895-898, Sep 19, 1996. Correspondence

This article has been cited by other articles:

• Ayanian, J. Z. (2009). The Elusive Quest for Quality and Cost Savings in the Medicare Program. JAMA 301: 668-670 [Full Text]  
• Jack, B. W., Chetty, V. K., Anthony, D., Greenwald, J. L., Sanchez, G. M., Johnson, A. E., Forsythe, S. R., O'Donnell, J. K., Paasche-Orlow, M. K., Manasseh, C., Martin, S., Culpepper, L. (2009). A Reengineered Hospital Discharge Program to Decrease Rehospitalization: A Randomized Trial. ANN INTERN MED 150: 178-187 [Abstract] [Full Text]  
• Chapko, M. K., Manheim, L. M., Guihan, M., Sullivan, J. H., Zhou, X.-H. A., Li Wang, , Mambourg, F. J., Hedrick, S. C. (2009). Assisted Living Pilot Program: Utilization and Cost Findings. J Aging Health 21: 208-225 [Abstract]  
• Katikireddi, S. V., Cloud, G. C. (2008). Planning a patient's discharge from hospital. BMJ 337: a2694-a2694 [Full Text]  
• Jaarsma, T., van der Wal, M. H. L., Lesman-Leegte, I., Luttik, M.-L., Hogenhuis, J., Veeger, N. J., Sanderman, R., Hoes, A. W., van Gilst, W. H., Lok, D. J. A., Dunselman, P. H. J. M., Tijssen, J. G. P., Hillege, H. L., van Veldhuisen, D. J., for the Coordinating Study Evaluating Outcomes of, (2008). Effect of Moderate or Intensive Disease Management Program on Outcome in Patients With Heart Failure: Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH). Arch Intern Med 168: 316-324 [Abstract] [Full Text]  
• Wilt, T. J., Niewoehner, D., MacDonald, R., Kane, R. L. (2007). Management of Stable Chronic Obstructive Pulmonary Disease: A Systematic Review for a Clinical Practice Guideline. ANN INTERN MED 147: 639-653 [Abstract] [Full Text]  
• Siempos, I. I., Dimopoulos, G., Korbila, I. P., Manta, K., Falagas, M. E. (2007). Macrolides, quinolones and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis. Eur Respir J 29: 1127-1137 [Abstract] [Full Text]  
• Holland, R., Brooksby, I., Lenaghan, E., Ashton, K., Hay, L., Smith, R., Shepstone, L., Lipp, A., Daly, C., Howe, A., Hall, R., Harvey, I. (2007). Effectiveness of visits from community pharmacists for patients with heart failure: HeartMed randomised controlled trial. BMJ 334: 1098-1098 [Abstract] [Full Text]  
• Wakefield, B. J., Holman, J. E. (2007). Functional Trajectories Associated With Hospitalization in Older Adults. West J Nurs Res 29: 161-177 [Abstract]  
• Sims, D. C., Jacob, J., Mills, M. M., Fett, P. A., Novak, G. (2006). Evaluation and Development of Potentially Better Practices to Improve the Discharge Process in the Neonatal Intensive Care Unit. Pediatrics 118: S115-S123 [Abstract] [Full Text]  
• Latour, C. H.M., de Vos, R., Huyse, F. J., de Jonge, P., van Gemert, L. A.M., Stalman, W. A.B. (2006). Effectiveness of Post-Discharge Case Management in General-Medical Outpatients: A Randomized, Controlled Trial. Psychosomatics 47: 421-429 [Abstract] [Full Text]  
• Sisk, J. E., Hebert, P. L., Horowitz, C. R., McLaughlin, M. A., Wang, J. J., Chassin, M. R. (2006). Effects of Nurse Management on the Quality of Heart Failure Care in Minority Communities: A Randomized Trial. ANN INTERN MED 145: 273-283 [Abstract] [Full Text]  
• Robbins, J. M., Webb, D. A. (2006). Hospital Admission Rates for a Racially Diverse Low-Income Cohort of Patients With Diabetes: The Urban Diabetes Study. AJPH 96: 1260-1264 [Abstract] [Full Text]  
• Yu, D. S.F., Thompson, D. R., Lee, D. T.F. (2006). Disease management programmes for older people with heart failure: crucial characteristics which improve post-discharge outcomes. Eur Heart J 27: 596-612 [Abstract] [Full Text]  
• Roccaforte, R., Demers, C., Baldassarre, F., K.Teo, K., Yusuf, S. (2005). Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta-analysis. Eur J Heart Fail 7: 1133-1144 [Abstract] [Full Text]  
• Daly, B. J., Douglas, S. L., Kelley, C. G., O'Toole, E., Montenegro, H. (2005). Trial of a Disease Management Program to Reduce Hospital Readmissions of the Chronically Critically Ill. Chest 128: 507-517 [Abstract] [Full Text]  
• de la Porte, P. W.F. B.-A., Lok, D. J.A., van Wijngaarden, J., Cornel, J. H., Pruijsers-Lamers, D., van Veldhuisen, D. J., Hoes, A. W. (2005). Heart failure programmes in countries with a primary care-based health care system. Are additional trials necessary? Design of the DEAL-HF study. Eur J Heart Fail 7: 910-920 [Abstract] [Full Text]  
• Authors/Task Force Members, , Swedberg, K., Writing Committee:, , Cleland, J., Dargie, H., Drexler, H., Follath, F., Komajda, M., Tavazzi, L., Smiseth, O. A., Other Contributors, , Gavazzi, A., Haverich, A., Hoes, A., Jaarsma, T., Korewicki, J., Levy, S., Linde, C., Lopez-Sendon, J.-L., Nieminen, M. S., Pierard, L., Remme, W. J. (2005). Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Eur Heart J 26: 1115-1140 [Full Text]  
• Ledwidge, M., Ryan, E., O'Loughlin, C., Ryder, M., Travers, B., Kieran, E., Walsh, A., McDonald, K. (2005). Heart failure care in a hospital unit: a comparison of standard 3-month and extended 6-month programs. Eur J Heart Fail 7: 385-391 [Abstract] [Full Text]  
• Martensson, J., Stromberg, A., Dahlstrom, U., Karlsson, J.-E., Fridlund, B. (2005). Patients with heart failure in primary health care: effects of a nurse-led intervention on health-related quality of life and depression. Eur J Heart Fail 7: 393-403 [Abstract] [Full Text]  
• Capomolla, S., Pinna, G., La Rovere, M. T., Maestri, R., Ceresa, M., Ferrari, M., Febo, O., Caporotondi, A., Guazzotti, G., Lenta, F., Baldin, S., Mortara, A., Cobelli, F. (2004). Heart failure case disease management program: a pilot study of home telemonitoring versus usual care. Eur Heart J Suppl 6: F91-F98 [Abstract] [Full Text]  
• Wagner, E. H. (2004). Deconstructing Heart Failure Disease Management. ANN INTERN MED 141: 644-646 [Full Text]  
• Kimmelstiel, C., Levine, D., Perry, K., Patel, A. R., Sadaniantz, A., Gorham, N., Cunnie, M., Duggan, L., Cotter, L., Shea-Albright, P., Poppas, A., LaBresh, K., Forman, D., Brill, D., Rand, W., Gregory, D., Udelson, J. E., Lorell, B., Konstam, V., Furlong, K., Konstam, M. A. (2004). Randomized, Controlled Evaluation of Short- and Long-Term Benefits of Heart Failure Disease Management Within a Diverse Provider Network: The SPAN-CHF Trial. Circulation 110: 1450-1455 [Abstract] [Full Text]  
• Gonseth, J., Guallar-Castillon, P., Banegas, J. R., Rodriguez-Artalejo, F. (2004). The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports. Eur Heart J 25: 1570-1595 [Abstract] [Full Text]  
• Gustafsson, F., Arnold, J. M. O. (2004). Heart failure clinics and outpatient management: review of the evidence and call for quality assurance. Eur Heart J 25: 1596-1604 [Abstract] [Full Text]  
• Mejhert, M, Kahan, T, Persson, H, Edner, M (2004). Limited long term effects of a management programme for heart failure. Heart 90: 1010-1015 [Abstract] [Full Text]  
• McAlister, F. A., Stewart, S., Ferrua, S., McMurray, J. J.J.V. (2004). Multidisciplinary strategies for the management of heart failure patients at high risk for admission: A systematic review of randomized trials. J Am Coll Cardiol 44: 810-819 [Abstract] [Full Text]  
• Neilson, E. G., Johnson, K. B., Rosenbloom, S. T., Dupont, W. D., Talbert, D., Giuse, D. A., Kaiser, A., Miller, R. A., the Resource Utilization Committee*, (2004). The Impact of Peer Management on Test-Ordering Behavior. ANN INTERN MED 141: 196-204 [Abstract] [Full Text]  
• Atienza, F., Anguita, M., Martinez-Alzamora, N., Osca, J., Ojeda, S., Almenar, L., Ridocci, F., Valles, F., de Velasco, J. A. (2004). Multicenter randomized trial of a comprehensive hospital discharge and outpatient heart failure management program. Eur J Heart Fail 6: 643-652 [Abstract] [Full Text]  
• Friedman, B., Basu, J. (2004). The Rate and Cost of Hospital Readmissions for Preventable Conditions. Med Care Res Rev 61: 225-240 [Abstract]  
• Phillips, C. O., Wright, S. M., Kern, D. E., Singa, R. M., Shepperd, S., Rubin, H. R. (2004). Comprehensive Discharge Planning With Postdischarge Support for Older Patients With Congestive Heart Failure: A Meta-analysis. JAMA 291: 1358-1367 [Abstract] [Full Text]  
• Wennberg, J. E, Fisher, E. S, Stukel, T. A, Skinner, J. S, Sharp, S. M, Bronner, K. K (2004). Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States. BMJ 328: 607- [Abstract] [Full Text]  
• Jaarsma, T., van der Wal, M. H.L., Hogenhuis, J., Lesman, I., Luttik, M.-L. A., Veeger, N. J.G.M., van Veldhuisen, D. J. (2004). Design and methodology of the COACH study: a multicenter randomised Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure. Eur J Heart Fail 6: 227-233 [Abstract] [Full Text]  
• Pearl, A., Wright, S. P, Gamble, G. D, Muncaster, S., Walsh, H. J, Sharpe, N., Doughty, R. N (2003). The effect of an integrated care approach for heart failure on general practice. Fam Pract 20: 642-645 [Abstract] [Full Text]  
• Sin, D. D., McAlister, F. A., Man, S. F. P., Anthonisen, N. R. (2003). Contemporary Management of Chronic Obstructive Pulmonary Disease: Scientific Review. JAMA 290: 2301-2312 [Abstract] [Full Text]  
• Ashton, C. M., Souchek, J., Petersen, N. J., Menke, T. J., Collins, T. C., Kizer, K. W., Wright, S. M., Wray, N. P. (2003). Hospital Use and Survival among Veterans Affairs Beneficiaries. NEJM 349: 1637-1646 [Abstract] [Full Text]  
• Cleland, J. G. F., Clark, A. L. (2003). Delivering the cumulative benefits of triple therapy to improve outcomes in heart failure: Too many cooks will spoil the broth. J Am Coll Cardiol 42: 1234-1237 [Full Text]  
• DeSalvo, K. B., Block, J. P., Muntner, P., Merrill, W. (2003). Predictors of variation in office visit interval assignment. Int J Qual Health Care 15: 399-405 [Abstract] [Full Text]  
• De Geest, S., Scheurweghs, L., Reynders, I., Pelemans, W., Droogne, W., Van Cleemput, J., Leventhal, M., Vanhaecke, J. (2003). Differences in psychosocial and behavioral profiles between heart failure patients admitted to cardiology and geriatric wards. Eur J Heart Fail 5: 557-567 [Abstract] [Full Text]  
• Clancy, D. E., Cope, D. W., Magruder, K. M., Huang, P., Wolfman, T. E. (2003). Evaluating Concordance to American Diabetes Association Standards of Care for Type 2 Diabetes Through Group Visits in an Uninsured or Inadequately Insured Patient Population. Diabetes Care 26: 2032-2036 [Abstract] [Full Text]  
• Jaarsma, T., Stromberg, A., Martensson, J., Dracup, K. (2003). Development and testing of the European Heart Failure Self-Care Behaviour Scale. Eur J Heart Fail 5: 363-370 [Abstract] [Full Text]  
• Laramee, A. S., Levinsky, S. K., Sargent, J., Ross, R., Callas, P. (2003). Case Management in a Heterogeneous Congestive Heart Failure Population: A Randomized Controlled Trial. Arch Intern Med 163: 809-817 [Abstract] [Full Text]  
• Niti, M, Ng, T P (2003). Avoidable hospitalisation rates in Singapore, 1991-1998: assessing trends and inequities of quality in primary care. J. Epidemiol. Community Health 57: 17-22 [Abstract] [Full Text]  
• Flynn, K. E., Smith, M. A., Davis, M. K. (2002). From Physician to Consumer: The Effectiveness of Strategies to Manage Health Care Utilization. Med Care Res Rev 59: 455-481 [Abstract]  
• Capomolla, S., Febo, O., Ceresa, M., Caporotondi, A., Guazzotti, G., La Rovere, M. T., Ferrari, M., Lenta, F., Baldin, S., Vaccarini, C., Gnemmi, M., Pinna, G., Maestri, R., Abelli, P., Verdirosi, S., Cobelli, F. (2002). Cost/utility ratio in chronic heart failure: comparison between heart failure management program delivered by day-hospital and usual care. J Am Coll Cardiol 40: 1259-1266 [Abstract] [Full Text]  
• Sackley, C., Pound, K. (2002). Setting priorities for a discharge plan for stroke patients entering nursing home care. Clin Rehabil 16: 859-866 [Abstract]  
• Cline, C. (2002). Nurse-led clinics for heart failure in Sweden--doing the right thing?. Eur J Heart Fail 4: 393-394 [Full Text]  
• Mark, D. B., Hlatky, M. A. (2002). Medical Economics and the Assessment of Value in Cardiovascular Medicine: Part II. Circulation 106: 626-630 [Full Text]  
• Sackley, C. M, Pound, K. (2002). Stroke patients entering nursing home care: a content analysis of discharge letters. Clin Rehabil 16: 736-740 [Abstract]  
• Wakefield, B. J. (2002). Risk for Acute Confusion on Hospital Admission. Clin Nurs Res 11: 153-172 [Abstract]  
• Brumley, R. D., de Denus, S., Spinler, S. A., Jerant, A. F., Stevenson, L. W. (2002). Treatment of Congestive Heart Failure. JAMA 287: 2209-2210 [Full Text]  
• Riegel, B., Carlson, B., Kopp, Z., LePetri, B., Glaser, D., Unger, A. (2002). Effect of a Standardized Nurse Case-Management Telephone Intervention on Resource Use in Patients With Chronic Heart Failure. Arch Intern Med 162: 705-712 [Abstract] [Full Text]  
• Cohen, H. J., Feussner, J. R., Weinberger, M., Carnes, M., Hamdy, R. C., Hsieh, F., Phibbs, C., Courtney, D., Lyles, K. W., May, C., McMurtry, C., Pennypacker, L., Smith, D. M., Ainslie, N., Hornick, T., Brodkin, K., Lavori, P. (2002). A Controlled Trial of Inpatient and Outpatient Geriatric Evaluation and Management. NEJM 346: 905-912 [Abstract] [Full Text]  
• Nohria, A., Lewis, E., Stevenson, L. W. (2002). Medical Management of Advanced Heart Failure. JAMA 287: 628-640 [Abstract] [Full Text]  
• Doughty, R.N., Wright, S.P., Pearl, A., Walsh, H.J., Muncaster, S., Whalley, G.A., Gamble, G., Sharpe, N. (2002). Randomized, controlled trial of integrated heart failure management. The Auckland Heart Failure Management Study. Eur Heart J 23: 139-146 [Abstract] [Full Text]  
• Ferris, T. G., Chang, Y., Blumenthal, D., Pearson, S. D. (2001). Leaving Gatekeeping Behind -- Effects of Opening Access to Specialists for Adults in a Health Maintenance Organization. NEJM 345: 1312-1317 [Abstract] [Full Text]  
• Douglas, S. L., Daly, B. J., Brennan, P. F., Gordon, N. H., Uthis, P. (2001). Hospital Readmission Among Long-term Ventilator Patients. Chest 120: 1278-1286 [Abstract] [Full Text]  
• Stevens, D. P., Holland, G. J., Kizer, K. W. (2001). Results of a Nationwide Veterans Affairs Initiative to Align Graduate Medical Education and Patient Care. JAMA 286: 1061-1066 [Abstract] [Full Text]  
• Task Force for the Diagnosis and Treatment of Chro, , Remme, W. J., Swedberg, K. (2001). Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J 22: 1527-1560  
• Donaldson, M. S. (2001). Continuity of Care: A Reconceptualization. Med Care Res Rev 58: 255-290 [Abstract]  
• Bach, P. B., Brown, C., Gelfand, S. E., McCrory, D. C. (2001). Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Summary and Appraisal of Published Evidence. ANN INTERN MED 134: 600-620 [Abstract] [Full Text]  
• McCrory, D. C., Brown, C., Gelfand, S. E., Bach, P. B. (2001). Management of Acute Exacerbations of COPD : A Summary and Appraisal of Published Evidence. Chest 119: 1190-1209 [Abstract] [Full Text]  
• McDonald, K., Ledwidge, M., Cahill, J., Kelly, J., Quigley, P., Maurer, B., Begley, F., Ryder, M., Travers, B., Timmons, L., Burke, T. (2001). Elimination of early rehospitalization in a randomized, controlled trial of multidisciplinary care in a high-risk, elderly heart failure population: the potential contributions of specialist care, clinical stability and optimal angiotensin-converting enzyme inhibitor dose at discharge. Eur J Heart Fail 3: 209-215 [Abstract] [Full Text]  
• Schraeder, C., Shelton, P., Sager, M. (2001). The Effects of a Collaborative Model of Primary Care on the Mortality and Hospital Use of Community-Dwelling Older Adults. J Gerontol A Biol Sci Med Sci 56: M106-M112 [Abstract] [Full Text]  
• Fihn, S. D. (2000). Does VA Health Care Measure up?. NEJM 343: 1963-1965 [Full Text]  
• Grady, K. L., Dracup, K., Kennedy, G., Moser, D. K., Piano, M., Stevenson, L. W., Young, J. B. (2000). Team Management of Patients With Heart Failure : A Statement for Healthcare Professionals From the Cardiovascular Nursing Council of the American Heart Association. Circulation 102: 2443-2456 [Full Text]  
• Broyles, R. S., Tyson, J. E., Heyne, E. T., Heyne, R. J., Hickman, J. F., Swint, M., Adams, S. S., West, L. A., Pomeroy, N., Hicks, P. J., Ahn, C. (2000). Comprehensive Follow-up Care and Life-Threatening Illnesses Among High-Risk Infants: A Randomized Controlled Trial. JAMA 284: 2070-2076 [Abstract] [Full Text]  
• Mapel, D. W., Hurley, J. S., Frost, F. J., Petersen, H. V., Picchi, M. A., Coultas, D. B. (2000). Health Care Utilization in Chronic Obstructive Pulmonary Disease: A Case-Control Study in a Health Maintenance Organization. Arch Intern Med 160: 2653-2658 [Abstract] [Full Text]  
• Benbassat, J., Taragin, M. (2000). Hospital Readmissions as a Measure of Quality of Health Care: Advantages and Limitations. Arch Intern Med 160: 1074-1081 [Abstract] [Full Text]  
• Green, C. P., Porter, C. B., Bresnahan, D. R., Spertus, J. A. (2000). Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol 35: 1245-1255 [Abstract] [Full Text]  
• Wagner, E. H (2000). The role of patient care teams in chronic disease management. BMJ 320: 569-572 [Full Text]  
• Marrie, T. J., Lau, C. Y., Wheeler, S. L., Wong, C. J., Vandervoort, M. K., Feagan, B. G., for the CAPITAL Study Investigators, (2000). A Controlled Trial of a Critical Pathway for Treatment of Community-Acquired Pneumonia. JAMA 283: 749-755 [Abstract] [Full Text]  
• DeSalvo, K. B., Bowdish, B. E., Alper, A. S., Grossman, D. M., Merrill, W. W. (2000). Physician Practice Variation in Assignment of Return Interval. Arch Intern Med 160: 205-208 [Abstract] [Full Text]  
• Anttila, S. K, Huhtala, H. S, Pekurinen, M. J, Pitkajarvi, T. K (2000). Cost-effectiveness of an innovative four-year post-discharge programme for elderly patients: Prospective follow-up of hospital and nursing home use in project elderly and randomized controls. Scand J Public Health 28: 41-46 [Abstract]  
• Gattis, W. A., Hasselblad, V., Whellan, D. J., O'Connor, C. M. (1999). Reduction in Heart Failure Events by the Addition of a Clinical Pharmacist to the Heart Failure Management Team: Results of the Pharmacist in Heart Failure Assessment Recommendation and Monitoring (PHARM) Study. Arch Intern Med 159: 1939-1945 [Abstract] [Full Text]  
• Oddone, E. Z., Horner, R. D., Sloane, R., McIntyre, L., Ward, A., Whittle, J., Passman, L. J., Kroupa, L., Heaney, R., Diem, S., Matchar, D. (1999). Race, Presenting Signs and Symptoms, Use of Carotid Artery Imaging, and Appropriateness of Carotid Endarterectomy. Stroke 30: 1350-1356 [Abstract] [Full Text]  
• Jaarsma, T., Halfens, R., Huijer Abu-Saad, H., Dracup, K., Gorgels, T., van Ree, J., Stappers, J. (1999). Effects of education and support on self-care and resource utilization in patients with heart failure. Eur Heart J 20: 673-682 [Abstract]  
• Naylor, M. D., Brooten, D., Campbell, R., Jacobsen, B. S., Mezey, M. D., Pauly, M. V., Schwartz, J. S. (1999). Comprehensive Discharge Planning and Home Follow-up of Hospitalized Elders: A Randomized Clinical Trial. JAMA 281: 613-620 [Abstract] [Full Text]  
• Fisher, E. S., Welch, H. G. (1999). Avoiding the Unintended Consequences of Growth in Medical Care: How Might More Be Worse?. JAMA 281: 446-453 [Abstract] [Full Text]  
• ERHARDT, L., CLINE, C. (1998). Heart failure clinics: a possible means of improving care. Heart 80: 428-429 [Full Text]  
• Cline, C M J, Israelsson, B Y A, Willenheimer, R B, Broms, K, Erhardt, L R (1998). Cost effective management programme for heart failure reduces hospitalisation. Heart 80: 442-446 [Abstract] [Full Text]  
• Schwartz, C. E, Brotman, S., LaRocca, N., Lee, H. (1998). Patient perception of quality of care provided by specialists and generalists. Mult Scler 4: 426-432 [Abstract]  
• Goodman, D. C., Little, G. A. (1998). General Pediatrics, Neonatology, and the Law of Diminishing Returns. Pediatrics 102: 396-398 [Full Text]  
• Gill, J. M., Mainous III, A. G. (1998). The Role of Provider Continuity in Preventing Hospitalizations. Arch Fam Med 7: 352-357 [Abstract] [Full Text]  
• Stewart, S., Pearson, S., Horowitz, J. D. (1998). Effects of a Home-Based Intervention Among Patients With Congestive Heart Failure Discharged From Acute Hospital Care. Arch Intern Med 158: 1067-1072 [Abstract] [Full Text]  
• Tuuponen, T., Keistinen, T., Kivelaa, S.-L. (1997). Regional differences in long-term mortality among hospital-treated asthma and COPD patients. Scand J Public Health 25: 238-242 [Abstract]  
• Ellrodt, G., Cook, D. J., Lee, J., Cho, M., Hunt, D., Weingarten, S. (1997). Evidence-Based Disease Management. JAMA 278: 1687-1692 [Abstract]  
• Hanumanthu, S., Butler, J., Chomsky, D., Davis, S., Wilson, J. R. (1997). Effect of a Heart Failure Program on Hospitalization Frequency and Exercise Tolerance. Circulation 96: 2842-2848 [Abstract] [Full Text]  
• O'Donnell, J. C., Toseland, R. W. (1997). Does Geriatric Evaluation and Management Improve the Health Behavior of Older Veterans in Psychological Distress?. J Aging Health 9: 473-497 [Abstract]  
• Goldberg, R. J., Meyer, T. E. (1997). Advances and Stagnations in Heart Failure. Arch Intern Med 157: 17-19 [Abstract]  
• Henley, D. E., Starfield, B., Parrino, T. A., Snider, G. L., Colucci, W. S., Sawin, C. T., Magill, M. K., Babitz, M., Silver, M. P., Rich, M. W., Corey, G. A., Burack, J. H., Portnoi, V. A., Adams, W. L., Weinberger, M., Oddone, E. Z., Henderson, W. G., Welch, H. G. (1996). A Trial of Increased Access to Primary Care. NEJM 335: 895-898 [Full Text]  
• (1996). DOES PRIMARY CARE REDUCE HOSPITALIZATION?. JWatch General 1996: 2-2 [Full Text]  
• Welch, H. G. (1996). Questions about the Value of Early Intervention. NEJM 334: 1472-1473 [Full Text]