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Background: Data on the long-term benefits of nonspecific disease management programs are limited. We performed a long-term follow-up of a previously published randomized trial. Methods: We compared all-cause mortality and recurrent hospitalization during median follow-up of 7.5 years in a heterogeneous cohort of patients with chronic illness initially exposed to a multidisciplinary, homebased intervention (HBI) (n = 260) or to usual postdischarge care (n= 268). Results: During follow-up, HBI had no impact on allcause mortality (relative risk, 1.04; 95% confidence interval, 0.80-1.35) or event-free survival from death or unplanned hospitalization (relative risk, 1.03; 95% confidence interval, 0.86-1.24). Initial analysis suggested that HBI had only a marginal impact in reducing unplanned hospitalization, with 677 readmissions vs 824 for the usual care group (mean ± SD rate, 0.72 ± 0.96 vs 0.84 ± 1.20 readmissions/patient per year; P=.08). When accounting for increased hospital activity in HBI patients with chronic obstructive pulmonary disease during follow-up for 2 years, post hoc analyses showed that HBI reduced readmissions by 14% within 2 years in patients without this condition (mean±SD rate, 0.54±0.72 vs 0.63±0.88 readmission/ patient per year; P=.04) and by 21% in all surviving patients within 3 to 8 years (mean±SD rate, 0.64±1.26 vs 0.81±1.61 readmissions/patient per year; P=.03). Overall, recurrent hospital costs were significantly lower (14%) in the HBI group

Police have increasingly regarded intervention for and offering assistance to domestic violence victims as an appropriate criminal justice intervention. However, variability in police responding as demonstrated by victim satisfaction surveys has been evident. Using Stark's (1996) suggested standard of victim empowerment to determine the efficacy of police interventions, this study sought to determine from both police and victim perspectives, what dimensions of police interventions were central to victim empowerment. A total of 63 victims and 28 police were interviewed. Results yielded three dimensions of empowerment along which police responses varied: integrated team versus isolated unit functioning, deserving versus undeserving victim perspective, and proactive versus pro–forma responses. Police attitudes, situational factors, and victim characteristics influenced the extent to which responses were experienced as empowering or disempowering by victims.

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Wheelchair prescription for individuals with a spinal cord injury is a highly complex and challenging clinical intervention. Evidence exists that successful outcomes are not always achieved for the wheelchair user and that therapists are experiencing increasing pressure to be accountable for and to justify their wheelchair prescription practice. This paper describes the process of establishing an evaluation of wheelchair prescription practices by occupational therapists in a spinal injury rehabilitation unit in South Australia. The evaluation process centred on the development of standards of practice to monitor performance and led to improvements in: (i) service delivery practices; (ii) wheelchair user participation; and (iii) accountability and justification of service delivery. Steps taken to develop the standards of practice to monitor performance and the benefits and limitations of the evaluation are described. K E Y W O R D S wheelchair prescription, standards of practice, spinal cord injury.