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Biomedical subjects

B Dickey

Publications and source records attributed to B Dickey.

48 records · Page 3Linked to original sources
PubMed1981

A follow-up of deinstitutionalized chronic patients four years after discharge.

Twenty-seven chronically ill mental patients were followed up four years after their discharge from a state hospital to the Massachusetts Mental Health Center. In interviews with the patients and their caregivers, data were gathered on the patients' current places of residence, mental status, time spent in the hospital since discharge, levels of functioning, and quality of life. The authors found that patients tended to move from hospital to community, with rehospitalization dropping dramatically once patients were placed in the community; that the group of patients living in the community had a better average mental status; that all but two patients preferred their current living situations to life at the state hospital; and that the best predictor of community residence was age at first admission (over 20). Two policy issues are discussed: the relationship (or lack of one) between restrictiveness and type of residence, and the importance to the findings of changes in psychiatric practice over the lifetime of the sample.

Adult↗
PubMed1981

Alternative to the back ward: the quarterway house.

The Quarterway House was founded in December 1978 to deinstitutionalize and provide rehabilitation services to a small group of long-term, seriously ill inpatients of the Massachusetts Mental Health Center. The purposes of the residential program are to provide a less institutional therapeutic environment and to develop a psychosocial treatment program that might enable some patients to move toward more independent settings in the community. In a randomized experimental study, with center inpatients as the control group, the effectiveness of the program was assessed by multiple outcome measures before the program began and at one year. Although neither group moved rapidly to more independent community living, Quarterway House patients showed improvement in general functioning and socialization-survival skills and decreased medication and seclusion. They did not show a decline in psychotic symptoms, obstreperousness, or antisocial behavior. Over-all, the findings suggest the program may prove useful for the long-term rehabilitation of severely ill patients.

Activities of Daily Living↗
PubMedDate not supplied

Outcome assessment in women's mental health.

This is the fifth in a series of six papers that will be published from the 1999 lecture series on "Quality Assessment in Women's Health Care" held at the University of Michigan School of Public Health. The lectures are presented by leaders in women's health research, and they explore key issues in the definition, measurement, and improvement of quality in women's health services. The series is supported by an unrestricted educational grant from Pfizer Inc. and is presented by the Interdepartmental Concentration in Reproductive and Women's Health at the University of Michigan School of Public Health; the University of Michigan National Center of Excellence in Women's Health; and the Michigan Initiative for Women's Health. The series coordinator is Carol S. Weisman, PhD, and Catherine L. Maroney prepared the summary of the discussants' comments.

Female↗
PubMedDate not supplied

Barbara Dickey on outcomes measurement, continuous quality improvement, and performance indicators. Interview by Christy L. Beaudin.

Barbara Dickey, PhD, is director of the mental health services research department at McLean Hospital in Belmont, MA, and associate professor of psychology in the department of psychiatry at Harvard Medical School. Her research interests have focused on managed care and its effect on cost, outcomes, and quality. Related to these research interests is her work at McLean Hospital to use data-driven activities to improve the quality of patient care. Outcomes measurement, continuous quality improvement (CQI), and the use of performance indicators in the facility's widely distributed report cards, McLean Reports, are all supported by her department. She received the Partners in Excellence Award in 1996 from the Partners Health Care System, Inc., and has served on many ad hoc committees for the National Institute of Mental Health, National Institute of Alcohol and Drug Abuse, and the Agency for Health Care Policy and Research (AHCPR). Dr. Dickey is coeditor of Outcomes Assessment in Clinical Practice (1996) and the forthcoming book, Achieving Quality in Psychiatric and Substance Abuse Practice: Concepts and Case Reports.

Health Services Research↗
PubMedDate not supplied

A comparison of for-profit and not-for-profit hospitals on the cost of mental health admissions.

The debate around health reform has raised questions about costs of care and the nature of competition in the delivery of care. This study examines whether the profit incentive leads to more-cost-efficient delivery of psychiatric and substance-abuse care. The data are from paid claims for 561 psychiatric and substance-abuse admissions in 1985-1987 from two very large national corporations with generous indemnity health plans that included nondiscriminatory mental health benefits. We found that episode-paid claims for admissions to for-profit facilities, after adjustments for case-mix and facility type, were higher. The stays of children in for-profit hospitals, relative to those of adults, were longer and more expensive.

Adult↗
PubMedDate not supplied

Assessing the quality of psychiatric care: research methods and application in clinical practice.

The drive to contain the costs of health care in the United States is focusing attention on how quality of care is affected. This article discusses research methods for assessing the quality of psychiatric care and reviews findings from some major studies evaluating care. These findings are mixed, highlighting areas in which quality of care is less than optimal, as well as the importance of continued research and the need to develop better research methods. Evidence-based criteria and more-sensitive risk-adjustment techniques must be employed if data on quality are to yield fair comparisons among health plans. The challenge is to refine the methods now in use at both the research and clinical levels, so that better-quality assessments can be made for policy formulation, physician education, and consumer choice.

Evidence-Based Medicine↗
PubMedDate not supplied

How managed care organizations develop selective contracting networks for psychiatric inpatient care: a Massachusetts case study.

Medicaid agencies recently have adopted selective contracting to control use and costs of publicly financed behavioral health care. This case study describes formation of an inpatient network for serving psychiatrically disabled Medicaid beneficiaries in Massachusetts. Network formation is seen as a two-stage process: hospitals first decide to bid for a contract, and form a pool from which the managed care organization chooses hospitals. We used logit models to predict how hospital experience with Medicaid patients, competition, prior reimbursement rates, and geographic distribution affected these two stages. Hospitals are more likely to bid if they have treated more psychiatric inpatients and more disabled Medicaid inpatients receiving Supplemental Security Income. Managed care organizations take into account hospitals' experience with Medicaid patients and geographic dispersion, but not prior reimbursement rates.

Competitive Bidding↗