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Biomedical subjects

B Dickey

Publications and source records attributed to B Dickey.

At least 37 records · Page 2Linked to original sources
PubMed1995

The imperative of outcome assessment in psychiatry.

This report describes the current conceptualization of outcome assessment in psychiatry and focuses on how assessment instruments can be built into psychiatric facility-based practice. First, the domains of clinical assessment are outlined, with an emphasis on three elements: level of psychiatric symptoms, clinical functioning, and patient satisfaction. Examples of outcome instruments then are provided as well as the elements of their successful implementation. Finally, the value of linking outcome assessment to data on patient characteristics and service utilization are discussed in order to gain insight into the relationship between treatment and outcome. The clinical, fiscal, and regulatory imperatives emerging for outcome assessment call for its demystification and widespread application.

Hospitals, Psychiatric↗
PubMed1994

Evaluating mental health care reform: including the clinician, client, and family perspective.

This article suggests one direction that theory building might take to develop a stronger conceptual foundation needed to test the effect on clients of reforms in the financing and organization of mental health care delivery systems. The authors recommend that health status outcomes be measured from three perspectives: the client, who can best report his or her own subjective experience of illness; the clinician, who is the best source of information about the client's disease; and the family, which is the best source of information about the effects on members' health status of caring for a mentally ill family member. The authors also recommend that measurement of health status should be multidimensional.

Attitude of Health Personnel↗
PubMed1990

Patterns of service use and costs in model day hospital-in programs in Boston and Tucson.

Patterns of service use and costs in two similar model day hospital-inn programs for psychiatric patients in publicly funded hospitals in Boston and Tucson are compared. Implementation of the programs resulted in cost savings at both sites, although mean annual costs per patient were much lower in Tucson than in Boston. Compared with patients at the Boston site, patients in Tucson had more admissions but shorter stays and fewer days in the program during a 12-month follow-up period. Site-specific differences in the programs, in local practice patterns, and in state mental health funding levels may have influenced cost differences.

Arizona↗
PubMed1989

Containing mental health treatment costs through program design: a Massachusetts study.

A single site pre-post study of seriously mentally ill patients treated in a public mental health system shows that annual treatment costs can be substantially reduced with the use of day hospital treatment. Two cohorts of psychiatric patients--282 consecutive admissions to a traditional public inpatient unit in 1980, and 340 consecutive admissions to a combination of inpatient and day hospital care in 1984--were followed 12 months after admission. The substitution of the day hospital is made possible because the facility provided a dormitory residence for those who could not go home at night. Cost savings per hospital episode are about 31 per cent when the additional costs of day hospital and residence are considered. Cost shifting from inpatient to residential sites is noted, but overall mean annual costs, when all other treatment (including additional admissions), residential and family costs were included, are reduced. Readmission rates did not rise. The generalizability of the findings is limited to public mental health centers and state hospitals.

Adult↗
PubMed1987

Bringing psychiatric patients into the Medicare prospective payment system: alternatives to DRGs.

The basis of Medicare's prospective payment for alcohol, drug abuse, and mental illness hospital admissions has been the patient classification system known as diagnosis-related groups (DRGs). This paper describes two alternative patient classification systems, disease staging and clinically related groups, and reports how well each system predicts resource use compared to the DRG system. Medicare data from four states were used to test the comparative strength of these patient classification systems. Although disease staging and clinically related groups performed better than DRGs, they were still poor predictors of resource use.

Alcoholism↗
PubMed1987

Differences in resource use and cost among facilities treating alcohol, drug abuse, and mental disorders: implications for design of a prospective payment system.

Specialized psychiatric facilities, including qualified distinct-part units in general hospitals, are exempt from Medicare's diagnosis-related group prospective payment system (PPS). One major reason for continuing the exemption is the redistribution of revenue that would probably occur if a single national price were established for care at the diverse facilities that treat patients with psychiatric and substance abuse disorders. This study investigated the extent of such potential redistribution in a private health insurance data base and found that a PPS would systematically underpay specialized facilities and systematically overpay general hospitals without specialized units. Alternatives for addressing this problem are discussed.

Alcoholism↗
PubMed1986

Mental health cost models. Refinements and applications.

This paper describes a 2-year study whose goal was to refine Burton Weisbrod's cost model for public programs for the chronically mentally ill. The authors made comprehensive cost assessments of all the resources, including treatment programs, used by a small sample of severely disturbed chronically ill patients. Refinement of the model included a method to assess capital costs of public facilities. The use of disaggregated patient information permitted analysis of cost differences between patients when adjusted for case mix. Patient costs over the study period ranged from $24,000 to $99,000. Patient characteristics and change in clinical status account for 30% of the variance.

Adult↗
PubMed1986

The Quarterway House: a two-year cost study of an experimental residential program.

A comprehensive cost comparison was made of resource utilization by seriously disabled chronic psychiatric patients randomly assigned to inpatient care and to an experimental residential program that provided an intermediate level of 24-hour care. At the end of the two-year study period, no significant changes in patients' clinical condition were observed, but costs for the experimental group averaged about $14,500 less (in 1981 dollars) than for the controls. The cost model included all treatment costs and nontreatment costs such as medical care, community services, case management, law enforcement and fire safety, maintenance outside the mental health system, and collateral costs. The study findings suggest that a program such as this one may be a viable alternative to back-ward long-term care for seriously disabled chronic patients.

Adult↗
PubMed1985

Four-year assessment of a day hospital-inn program as an alternative to inpatient hospitalization.

The authors report on a new system of care in which all patients who require psychiatric hospitalization are admitted to a day hospital with an inn and an intensive care unit. Data on use of services, length of stay, recidivism, security, medical emergencies, staff accidents, and seclusion and restraint over a 4-year period suggest that the new delivery system provides care which is at least as effective as the previous system of care. Evidence is presented that the new system offers certain advantages, including less seclusion and restraint, fewer episodes of escape, and substantial cost savings.

Community Mental Health Centers↗
PubMed1985

From inpatient to inn status. A new residential model.

This article presents a new residential model that has been developed at the Massachusetts Mental Health Center. The "dormitory-inn" provides an alternative to 24-hour inpatient hospitalization for patients who traditionally would have been admitted and retained on inpatient services. Issues covered include hours and location, referrals, requirements for staff, medical and nursing coverage, and a review of the efficacy of the program.

Adolescent↗
PubMed1984

Career patterns of female and male graduates of a psychiatric residency program.

The authors surveyed 122 recent graduates of the Massachusetts Mental Health Center to determine whether previously reported differences in career patterns between the sexes persist in younger psychiatrists. Some of the findings are consistent with previous studies, e.g., women work fewer hours than men, take more time off for child rearing, and are less often Board certified. However, women surveyed were not underpaid compared with men, and men showed a growing awareness of the conflicting demands of career and family. The significance of these findings and their implications are discussed.

Adult↗
PubMed1984

Demonstration of C5 cleaving activity in bronchoalveolar fluids and cells: a mechanism of acute and chronic alveolitis.

Recently, we have demonstrated that preformed chemotactic fragments derived from C5 (C5fr), when instilled intratracheally, induce an intense acute alveolitis. An intense intrapulmonary inflammatory reaction, characterized by accumulation of large numbers of neutrophils in the alveolar spaces, also resulted from intratracheal instillation of purified human C5. Since purified C5 does not induce PMN chemotaxis in vitro and presumably native C5 is not phlogistic in vivo, a mechanism for C5 cleavage productive of chemotactic fragments may be operative within the lung. To explore the possibility that pulmonary-mediated fragmentation of C5 occurred, both in vitro and in vivo studies were undertaken. As described in this paper, extensive cleavage of 125I-labeled C5 was demonstrated in the bronchoalveolar lavage fluids (BALF) of hamster lungs previously instilled with 125I-labeled C5. In vitro incubation of 125I-labeled C5 with normal hamster lung lavage components, cells, and lavage fluid also cleaved 125I-labeled C5. Bioassay of such in vitro reactions also revealed potent chemotactic activity for polymorphonuclear leukocytes. A potent C5-cleaving activity was detected in fluid of normal bronchoalveolar lavage (BAL) recovered from normal hamster lungs. This BALF "enzyme activity" selectively cleaved C5 in vitro, producing potent C5-related chemotactic fragmentation products, but it did not fragment C3 nor did it produce C3 chemotactic factors in vitro. Cleavage of C5 by alveolar macrophages that produces chemotactic factors has previously been attributed to an acid protease of lysosomal origin. This "enzyme activity" is apparently distinct from elastase, collagenase, and trypsin since it is not inhibited by alpha 1-antitrypsin. In separate studies, we have recently demonstrated the ability of isolated lung cells to synthesize and secrete C3 and C5 in vitro. Thus, these studies suggest that the lung may intrinsically have the capacity to regulate inflammatory reactions by the localized production of both complement components (C3 and C5) as well as complement-activating systems (e.g., C5-cleaving activity of BALF).

Acute Disease↗