You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Do Post Discharge Phone Calls Improve Care Transitions? A Cluster-Randomized Trial
Abstract 1:
Importance The transition from hospital to home can expose patients to adverse events during the post discharge period . Post discharge care including phone calls may provide support for patients returning home but the impact on care transitions is unknown . Objective To examine the effect of a 72-hour post discharge phone call on the patient 's transition of care experience . Design Cluster-r and omized control trial . Setting Urban , academic medical center . Participants General medical patients age 18 and older discharged home after hospitalization . Main Outcomes and Measures Primary outcome measure was the Care Transition Measure ( CTM-3 ) score , a vali date d measure of the quality of care transitions . Secondary measures included self-reported adherence to medication and follow up plans , and 30-day composite of emergency department ( ED ) visits and hospital readmission . Results 328 patients were included in the study over an 6-month period . 114 ( 69 % ) received a post  discharge phone call , and 214 of all patients in the study completed the follow outcome survey ( 65 % response rate ) . A small difference in CTM-3 scores was observed between the intervention and control groups ( 1.87 points , 95 % CI 0.47–3.27 , p = 0.01 ) . Self-reported adherence to treatment plans , ED visits , and emergency readmission rates were similar between the two groups ( odds ratio 0.57 , 95 % CI 0.13–2.45 , 1.20 , 95 % CI 0.61–2.37 , and 1.18 , 95 % CI 0.53–2.61 , respectively ) . Conclusions and Relevance A single post discharge phone call had a small impact on the quality of care transitions and no effect on hospital utilization . Higher intensity post discharge support may be required to improve the patient experience upon returning home . Trial Registration Clinical Trials.gov


Title 2:
TransitionRx: Impact of community pharmacy postdischarge medication therapy management on hospital readmission rate.
Abstract 2:
OBJECTIVES To determine if a community pharmacy-based transition of care ( TOC ) program that included the full scope of medication therapy management ( MTM ) services ( TransitionRx ) decreased hospital readmissions , resolved medication-related problems , and increased patient satisfaction . DESIGN Prospect i ve , quasi-experimental study . SETTING Nine Kroger Pharmacies located in Western Cincinnati . PATIENTS Patients older than 18 years of age and discharged from two local hospitals with a diagnosis of congestive heart failure , chronic obstructive pulmonary disease , or pneumonia . Patients were recruited from two local hospitals and referred to the community pharmacy for MTM services with the pharmacist within 1 week of discharge . MAIN OUTCOME MEASURES Pharmacists reconciled the patients ' medications , identified drug therapy problems , recommended changes to therapy , and provided self-management education . At 30 days after discharge , research personnel conducted telephone surveys , using a previously vali date d survey instrument , to assess hospital readmissions and patient satisfaction . Pharmacist interventions and medication-related problems were documented . RESULTS A total of 90 patients completed the study . Of these , 20 % of patients in the usual care group were admitted to the hospital within 30 days compared with 6.9 % of patients in the intervention group ( P = 0.019 ) . In the 30 patients who received MTM services from the pharmacist , 210 interventions were made . The overall mean patient satisfaction with the TOC process was not significantly different between patients who were seen by the pharmacist and those who were not seen by the pharmacist . CONCLUSION Community pharmacies successfully collaborated with hospitals to develop a referral process for TOC interventions . Patients who received MTM services from the pharmacist experienced significantly fewer readmissions than patients who received usual care


Title 3:
Association of Early Post-Discharge Follow-Up by a Primary Care Physician and 30-Day Rehospitalization Among Older Adults
Abstract 3:
ABSTRACT BACKGROUND  Rehospitalizations within 30 days of discharge are responsible for a large portion of healthcare spending . One approach to preventing rehospitalizations is early follow-up , usually defined as an office visit with a primary care physician within 7 days of discharge — an approach that is being incentivized by health plans . However , evidence regarding its effectiveness is limited . OBJECTIVE We aim ed to determine whether an office visit with a primary care physician within 7 days after discharge is associated with 30-day rehospitalization . DESIGN This was an observational study set within a r and omized trial . PARTICIPANTS The study included patients age 65 and older receiving care from a multi-specialty group practice and discharged from hospital to home between 26 August 2010 and 25 August 2011 . To control for confounding , we identified characteristics of patients and hospital stays that are predictive of rehospitalization , and also developed high-dimensional propensity scores . Analyses used Cox proportional hazards models and took into account varying amounts of opportunity time for office visits . MAIN MEASURES We looked at 30-day rehospitalizations at any hospital . KEY RESULTS Of 3,661 patients discharged to home during the study year , 707 ( 19.3 % ) were rehospitalized within 30 days . Patients receiving an office visit  within 7 days numbered 1,808 ( 49.4 % ) , and of these , 1,000 ( 27.3 % ) were with a primary care physician . In models predicting rehospitalization , stratified on deciles of propensity score and controlling for additional confounders , the hazard ratios associated with office visits with a primary care physician within 7 days were 0.98 ( 95 % CI 0.80 , 1.21 ) ; for visits with any physician , the hazard ratio was HR 1.04 , ( 95 % CI 0.87 , 1.25 ) . CONCLUSIONS We found no protective effect for office visits within 7 days . Such visits may need to be specifically focused on a range of issues related to the specific reasons why patients are rehospitalized . It is likely that outpatient visits will need to be set within comprehensive transition programs


Title 4:
ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions
Abstract 4:
Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies


Title 5:
Effects of nurse-initiated telephone follow-up on self-efficacy among patients with chronic obstructive pulmonary disease.
Abstract 5:
AIM This paper reports a study to determine whether a nurse-initiated telephone follow-up programme could increase  patients ' self-efficacy  in managing dyspnoea and decrease health care service use . BACKGROUND Chronic obstructive pulmonary disease is a worldwide health problem and has been labelled a burdensome disease . Because of the fear of activity-induced dyspnoea , patients with chronic obstructive pulmonary disease lack the confidence to perform daily activities . Studies of cardiac and diabetic patients have shown that telephone follow-up care is an effective approach to increasing self-efficacy . However , little such research has been done with patients with chronic obstructive pulmonary disease . METHODS This was a r and omized controlled study . A total of 60 participants ( 30 telephone follow-up , 30 control ) with chronic obstructive pulmonary disease were recruited from an acute care hospital in Hong Kong . The Chinese Self-Efficacy Scale was used to assess self-efficacy . Measures of health care use were numbers of visits to an accident and emergency department , hospitalizations , and unscheduled visits by physicians . FINDINGS The self-efficacy scores ( U = 272.5 , P = 0.009 ) of patients who were followed up by telephone improved significantly compared with those of patients in the control group . Multiple regression analyses showed that telephone follow-up ( Beta = 0.33 , CI : 0.19 - 0.48 , P = 0.001 ) , the pulmonary rehabilitation programme ( Beta = 0.44 , CI : 0.16 - 0.72 , P = 0.003 ) , smoking ( Beta = 0.34 , CI : 0.09 - 0.57 , P = 0.009 ) , and health care use ( Beta = -0.27 , CI : -0.47-(-0.07 ) , P = 0.008 ) were significant factors in predicting patient self-efficacy . CONCLUSIONS Nurse-initiated telephone follow-up care was effective in increasing self-efficacy in managing dyspnoea . The study needs to be replicated in other setting to strengthen its external validity


Title 6:
Home intervention and predictor variables for rehospitalization in chronic obstructive pulmonary disease exacerbations.
Abstract 6:
BACKGROUND Chronic obstructive pulmonary disease ( COPD ) exacerbation increases mortality and re sources used associated with hospitalization . We studied whether early home monitoring reduces the rate of readmission and if there are any predictor variables . PATIENTS AND METHODS We performed a prospect i ve , controlled , parallel-group study in patients who were hospitalized for COPD . Patients whose residence was within less than 15 km from the hospital were assigned to an interventional group ( home visits by nurses about 48 - 72hours after discharge ) , the remainder were assigned to a conventional care group . The rate of rehospitalization within the first month was compared between the two groups , as well as those variables that showed a predictive capability . RESULTS Seventy one patients were included : 35 in the conventional care group and 36 in the interventional group . In the latter , the treatment was modified in 13 patients ( 36 % ) . The hospital readmission rate was 17 % , which was similar in both groups ( P=.50 ) . For every 5-year increase in age , the risk for readmission was 2.54 ( 95%CI , 1.06 - 5.07 ) and for each increase of 10mmHg in PaCO(2 ) , the risk of readmission was 8.34 ( 95%CI , 2.43 - 18.55 ) . CONCLUSIONS Early home monitoring did not decrease the readmission rate during the first month . Older age and high PaCO(2 ) are factors that identify the group with a high risk for rehospitalization
We did not find a difference in effectiveness between studies using a 7-day versus a 30-day follow-up .
Based on low- and very low- quality evidence , follow-up within 7 days and within 30 days of discharge from hospitalization for heart failure or COPD -compared with usual care or no follow-up-were both associated with a reduced risk of all-cause readmission , emergency department visits , and mortality .
Overall , there is a lack of large , method ologically robust studies specifically focusing on the effectiveness of 7-day follow-up after discharge in improving patient outcomes