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Biomedical subjects

B M Rohland

Publications and source records attributed to B M Rohland.

13 recordsLinked to original sources
PubMed1998

Implementation of Medicaid Managed Mental Health Care in Iowa: problems and solutions.

Under the terms of a 1915(b) waiver, Iowa implemented a statewide carve-out program in 1995 for the management of mental health services for Medicaid recipients by contracting with a private for-profit corporation. In this commentary, the strategy used to develop the Medicaid managed care contract in Iowa is briefly summarized. Problems that were encountered in program implementation and regulatory attempts to address those issues are described. Suggestions for other states regarding the development, implementation, and oversight of contracts for managed care so that they might be able to deliver comprehensive mental health care services with acceptable standards of care quality are offered. By including appropriate contract specifications, providing mechanisms for oversight, and enforcing standards of care in Medicaid managed care contracts, many problems that occurred in Iowa may have been minimized or avoided. This experience can provide a valuable lesson for similar program initiatives in other states.

Contract Services↗
PubMed1998

Capacity of rural community mental health centers to treat serious mental illness.

This study evaluates the capacity of rural community mental health center staff to treat persons with serious mental illness (SMI). A 20-item survey was mailed to 720 providers in 34 community mental health centers (CMHCs) in Iowa. Responses were received from 285/680 persons in 32/34 centers. The confidence and interest in receiving additional training in tasks necessary for the care of persons with SMI was assessed for staff members of various disciplines and both confidence and training interest was found to vary by discipline. Recommendations to enhance CMHC capacity to treat persons with SMI are discussed.

Community Health Centers↗
PubMed1998

A survey of county boards' views of funding for mental retardation versus funding for mental illness.

The state of Iowa mandates services for persons with mental retardation but not for those with mental illness, resulting in widely divergent spending for the two populations. Members of 98 of the 99 county boards of supervisors were interviewed to determine differences in attitudes about services and funding priorities. Respondents were more willing to provide supportive services to persons with mental retardation and acute treatment to persons with mental illness. Only 16 percent believed that persons with chronic mental illness should be a first priority for mental health funds. Respondents tended to disagree not about whether services should be funded but about who should fund them. Three-fourths believed that the state should fund such services.

Attitude to Health↗
PubMed1998

County funding of mental health services in a rural state.

Relationships between funding for mental illness in Iowa counties and county wealth, political activism, need for public services, rural culture, and policy makers' attitudes were examined. Counties with fewer people, lower proportions of persons with college education, higher proportions of rural and elderly residents, higher rates of poverty, and a higher proportion of income from farms spent less money on mental health services. Regression analysis indicated that the size of the county population and the proportion of persons receiving Medicaid funds explained 96 percent of the variation between county budgets.

Community Mental Health Services↗
PubMed1997

Psychiatric hospitalization decision making by CMHC staff.

The decision to recommend hospitalization for patients with psychiatric illness is often made on the basis of unknown reliability and validity. The purpose of this study was to examine the characteristics and reliability of self-reported psychiatric hospitalization decision making among staff at a Community Mental Health Center. Foremost among the results, the conditions that staff consider to be appropriate indicators of hospitalization show only modest reliability. Kappa interrater reliabilities of .10 to .60 persist across different staff types and different patient problems. Results from hypothetical cases support a micro-certainty, macro-uncertainty hypothesis: staff are highly confident in the appropriateness of their treatment recommendations, but the recommendations across staff are variable. The results empirically demonstrate the need to improve the reliability of the hospitalization decision, and to work towards valid outcomes-based hospitalization criteria.

Attitude of Health Personnel↗
PubMed1995

A survey of utilization of psychiatrists in community mental health centers in Iowa.

Community mental health centers in Iowa were surveyed by mail in 1993 to obtain quantitative data on the utilization of psychiatrists at the centers. Responses from all 37 centers indicated that they employed a total of 34 full-time-equivalent (FTE) psychiatrists, representing about 18 percent of the psychiatrist-hours available in the state. The mean number of psychiatrist-hours per week per center was 36.9. New patients waited a mean of 30 days for an initial assessment by a psychiatrist. Seventy-three percent of the centers indicated they could use additional psychiatrist-hours.

Community Mental Health Centers↗
PubMed1994

A small area analysis of psychiatric hospitalizations to general hospitals. Effects of community mental health centers.

Population-based psychiatric admission rates vary across geographic areas, but reasons for this variation are unknown. Insofar as Community Mental Health Centers (CMHCs) provide outpatient services that may deter the need for hospitalization, the presence and structural characteristics of CMHCs may have an impact on a population's psychiatric admission rates. This study uses small area analysis to examine how general hospital psychiatric admission rates are associated with CMHC characteristics. Based on a survey of all CMHCs in Iowa and corresponding small area variation data, it was found that population admission rates were higher in areas closer to the CMHC and lower in outlying catchment areas, adjusting for age, sex, and urban/rural differences in populations. There was little evidence that differences in staffing and service variables influenced admission rates, although greater CMHC staff coverage by social workers and psychiatric residents was associated with lower admission rates. The results suggest that CMHCs do not lower an area's hospitalization rate, and in fact, the presence of CMHCs may promote a "supplier-induced demand" phenomenon of higher admissions.

Community Mental Health Centers↗
PubMed1993

ECT in the treatment of the catatonic syndrome.

OBJECTIVE: To determine the efficacy of ECT in the treatment of the catatonic syndrome and to identify predictors of good response. METHOD: 28 cases of catatonia in 22 patients admitted to a psychiatry or medical psychiatry inpatient unit between January 1989 and June 1992 were retrospectively evaluated. Cases were included if they met criteria for catatonia as described by Kahlbaum, i.e., 4 or more signs including immobility, mutism, withdrawal, staring, rigidity, posturing/gimacing, negativism, waxy flexibility, echo phenomena, stereotypy, and verbigeration. Primary diagnoses were: Major Depressive Disorder (8), Bipolar Affective Disorder (5), schizophrenia (5), schizoaffective disorder (2) and organic mental disorder (2). Mean age was 54.5 years; sex ratio was 15 females to 7 males. Patients received a mean of 12.0 treatments with mean seizure duration 50.9 s (by EEG) per treatment. RESULTS: By Kahlbaum criteria, resolution of the catatonic syndrome occurred in 26 out of 28 cases (93%). The mean number of signs present per patient prior to ECT was 5.6 versus 0.93 following ECT (p = 0.00001). Overall, ECT brought about resolution of 83.5% of all symptoms with 98% resolution of primary symptoms and 74% resolution of secondary symptoms. CONCLUSIONS: ECT is an effective treatment of the catatonic syndrome. ECT is effective in the resolution of both cardinal (primary) and secondary signs of catatonia. In this study, there is not a statistically significant difference in the effectiveness of the resolution of catatonic symptoms in persons with affective disorder versus schizophrenia.

Adult↗
PubMedDate not supplied

Clinical significance of persistent amniotic fluid leakage after genetic amniocentesis.

Chronic amniotic fluid leakage is a rare complication of genetic amniocentesis. Pregnancy outcomes in two such patients are presented and six previous cases reviewed. Although chorioamnionitis has not been reported, potentially serious complications may occur including an increased risk for pre-term delivery and fetal skeletal deformity. While conservative management of post-amniocentesis amniotic fluid leakage is advocated, patients should be advised of these risks.

Adult↗