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Biomedical subjects

D M Hilty

Publications and source records attributed to D M Hilty.

14 recordsLinked to original sources
PubMed2001

Posttraumatic concerns: a patient-centered approach to outcome assessment after traumatic physical injury.

BACKGROUND: Approximately 2.5 million Americans are admitted to the hospital after traumatic physical injury each year. Few investigations have elicited patients' perspectives regarding posttraumatic outcomes. OBJECTIVE: To identify and categorize physically injured trauma survivors' posttraumatic concerns. RESEARCH DESIGN: Prospective longitudinal investigation; trauma survivors were interviewed during the post-injury hospitalization and again 1, 4, and 12 months after the trauma. SUBJECTS: Ninety-seven, randomly selected, English speaking, hospitalized survivors of motor vehicle-crashes or assaults. MEASURES: At the end of each interview patients were asked, "Of all the things that have happened to you since you were injured, what concerns you the most?" Using an iterative process and working by consensus, investigators categorized patient concerns in content domains. Concern domains were then compared with established measures of posttraumatic stress disorder (PTSD) symptoms and limitations in physical functioning. RESULTS: Seven categories of posttraumatic concerns were identified. During the course of the year, 73% of patients expressed physical health concerns, 58% psychological concerns, 53% work and finance concerns, 40% social concerns, 10% legal concerns, 10% medical concerns, and 20% uncodable concerns. Rater agreement on concern categorization was substantial (kappa = 0.72). The mean number of concerns expressed per patient gradually decreased over time (1 month mean = 1.51; 12 month mean = 1.26) and resembled the trajectories of PTSD symptoms and functional limitations. CONCLUSIONS: The concerns of physically injured trauma survivors are readily elicited and followed up during the course of the year after injury. Open-ended inquiry regarding posttraumatic concerns may complement standardized outcome assessments by identifying and contextualizing the outcomes of greatest importance to patients.

Adult↗
PubMed2001

Requirements for multidisciplinary teamwork in psychiatric rehabilitation.

Psychiatric rehabilitation by its very nature is multidisciplinary because of the many competencies required for its implementation. In promoting optimal levels of recovery from schizophrenia and other disabling mental disorders, teams must combine the expert contributions of professionals and paraprofessionals who can individualize a comprehensive array of evidence-based services with competency, consistency, continuity, coordination, collaboration, and fidelity. The authors describe the properties and functions of the multidisciplinary team and key attributes of effective teams. The importance of teams' involving clients, their relatives, and other supporters in setting personally relevant life goals is emphasized. The authors provide examples of the challenges posed by the need to individualize services and of the ways in which barriers to communication and coordination can be overcome. The roles of the various team members are described, including leadership roles and the unique role of the psychiatrist, in the context of newly emerging, evidence-based treatments for psychiatric rehabilitation.

Case Management↗
PubMed2000

Development of a telemedicine program: a review of 1,000 videoconferencing consultations.

OBJECTIVE: To examine the financial and organizational characteristics, demand for services, and satisfaction outcomes of a growing telemedicine program serving both urban or suburban and rural populations. DESIGN: Retrospective review of 1,000 consecutive telemedicine consultations in the University of California (UC) Davis Telemedicine Program. SETTING: Telemedicine videoconferencing units, used to integrate care in the UC Davis Health System among the UC Davis Medical Center and several urban or suburban primary care clinics, rural hospitals, and clinic affiliates. SUBJECTS: A total of 657 consecutive patients who consented to a telemedicine consultation. Main outcome measures Demographic information about the patient population, the rural and urban or suburban clinics, the types of specialty consultations, and telemedicine equipment used in the UC Davis Health System. Patient and physician satisfaction were measured on a 5-point Likert scale. RESULTS: Patients and primary care physicians reported high levels of satisfaction. Rural clinics requested more and a greater variety of specialist consultations than urban or suburban clinics. CONCLUSION: Although referring physicians and patients indicate a high level of satisfaction with telemedicine services and insurers are negotiating reimbursement policies, additional research must investigate the reasons why some payers, patients, and providers resist participation in these services.

Attitude of Health Personnel↗
PubMed1999

The psychotic patient.

Psychotic disorders are relatively rare in the primary care setting, compared with depressive and anxiety disorders, but patient suffering is significantly higher for patients with psychotic symptoms. Primary care physicians are assuming more responsibility for the area of these patients in today's managed care environment. The practitioner needs to eliminate medical, substance, and mood origins of the psychotic symptoms before assuming a patient has a psychotic disorder (e.g., schizophrenia). This article outlines a diagnostic and treatment approach for patients with psychotic symptoms who are managed in the primary care setting.

Algorithms↗
PubMed1999

A review of bipolar disorder among adults.

OBJECTIVE: This paper reviews the epidemiology, etiology, assessment, and management of bipolar disorder. Special attention is paid to factors that complicate treatment, including noncompliance, comorbid disorders, mixed mania, and rapid cycling. Advances in biopsychosocial treatments are briefly reviewed, including new health service models for providing care. METHODS: A MEDLINE search was done for the period from January 1988 through October 1997 using the key terms of bipolar disorder, diagnosis, and treatment. Papers selected for further review included those published in English in peer-reviewed journals. Preference was given to articles reporting randomized, controlled trials. RESULTS: Bipolar disorder is a major public health problem. The etiology of the disorder appears multifactorial. Diagnosis often occurs years after onset of the disorder. Comorbid conditions are common. Management includes a lifetime course of medication and attention to psychosocial issues for patients and their families. Standardized treatment guidelines for the management of acute mania have been developed. New potential treatments are being investigated. CONCLUSIONS: Assessment of bipolar disorder must include careful attention to comorbid disorders and predictors of compliance. Randomized trials are needed to further evaluate the efficacy of medication, psychosocial interventions, and other health service interventions, particularly as they relate to the management of acute bipolar depression, bipolar disorder co-occurring with other disorders, and maintenance prophylactic treatment.

Adult↗
PubMed1998

How C-L services can comply with new HCFA guidelines.

A psychiatric consultation report form was developed to efficiently and accurately meet the stringent Medicare documentation guidelines that go into effect July 8, 1998. This form was designed for use in academic institutions where the consultation team includes teaching physicians, psychiatric residents, and medical students. Medicare has strict requirements regarding who may document each element of the consultation for billing purposes. These requirements were taken into account in the design of this form. Two academic consultation-liaison psychiatric services piloted the form and conducted internal audits to evaluate its usefulness. The accuracy of billing improved twofold at one site because the form facilitated rapid completion of details requisite to justify CPT codes of complex assessments. This saved considerable time and effort over the previous methods used to determine an appropriate level of billing. Critical information was documented more frequently, thereby meeting the documentation requirements more consistently. Instructions for use, criticisms, and cautions are given.

Academic Medical Centers↗
PubMed1998

Patient satisfaction with telemedicine consultation in primary care: comparison of ratings of medical and mental health applications.

OBJECTIVE: To assess the viability of telemedicine as a vehicle for offering mental health consultations to primary-care patients. METHODS: Satisfaction ratings from 34 mental health encounters were compared with ratings from a convenience sample of 59 non-mental health encounters on four aspects of satisfaction: self-reported ability to speak freely; probability of further use of telemedicine; perceived experience of telemedicine personnel; and relative preference for a telemedicine visit compared with a face-to-face visit. The study was conducted in the context of the Telemedicine Program at the University of California, Davis. RESULTS: No significant differences in satisfaction were found between mental health and non-mental health encounter groups for any of the four aspects of satisfaction. CONCLUSIONS: Ratings from patients receiving mental health consultation using telemedicine yielded levels of satisfaction similar to those found in telemedicine consultations in non-mental health medical areas. The results support telemedicine as a means to extend mental health consultation to rural primary-care patients.

Adjustment Disorders↗
PubMedDate not supplied

Follow-up consultation billing and documentation.

Frequently, bills are not submitted for follow-up visits for patients who have been evaluated psychiatrically on medical-surgical services. There often is confusion regarding which procedure codes are most appropriate to use in billing. To help the consultant understand the documentation requirements for various procedure codes, information from several sources was synthesized and distilled. This paper should help minimize documentation errors and maximize reimbursement for clinical services. The authors have reviewed available billing choices, and clarified the documentation requirements for different procedure codes according to Medicare regulations.

Accounting↗