Biomedical subjects

E A Latimer

Publications and source records attributed to E A Latimer.

8 recordsLinked to original sources

PubMed2001

Economic impacts of supported employment for persons with severe mental illness.

BACKGROUND: Most persons with severe mental illness prefer competitive to sheltered vocational settings. Supported employment (SE) has become a clearly defined model for helping people with severe mental illness to find and maintain competitive jobs. It involves individualized and rapid placement, ongoing support and assessment, and integration of vocational and mental health staff within a single clinical team. Previous studies show that SE secures competitive employment much more effectively than do other approaches. This review focuses on its economic impacts. METHODS: Studies reporting some service use or monetary outcomes of adding SE programs were identified. These outcomes were tabulated and are discussed in narrative form. RESULTS: Five nonrandomized and 3 randomized studies compare SE programs with day treatment or transitional employment programs. The introduction of SE services can result in anything from an increase to a decrease in vocational service costs, depending on the extent to which they substitute for previous vocational or day treatment services. Overall service costs tend to be lower, but differences are not significant. Earnings increase only slightly on average. CONCLUSIONS: Converting day treatment or other less effective vocational programs into SE programs can be cost-saving or cost-neutral from the hospital, community centre, and government points of view. Investments of new money into SE programs are unlikely to be materially offset by reductions in other health care costs, by reductions in government benefit payments, or by increased tax revenues. Such investments must be motivated by the value of increasing the community integration of persons with severe mental illness.

Canada↗

PubMed1999

Economic impacts of assertive community treatment: a review of the literature.

BACKGROUND: Assertive community treatment (ACT) is an extensively studied and widely imitated community support treatment model for severely mentally ill individuals. Several previous reviews have documented its favourable effects on clients and their families. This is the first review to focus on economic outcomes. METHODS: Nineteen randomized studies and 15 nonrandomized studies describing ACT programs were identified based on 2 criteria: 1) provision of services primarily in the community and 2) shared caseloads. Percentage reduction in hospital days was calculated for the 34 study sites where reported data allowed it. Multiple-regression methods were used to relate reduction in hospital days to program fidelity and other contextual factors. The impacts of ACT on emergency-room use, use of outpatient services, housing, costs, and other economic outcomes were also examined. RESULTS: Higher-fidelity programs appear to reduce hospital days by about 23 percentage points more than lower-fidelity programs (95% CI = -41.2, -5.2). The estimated regression coefficients imply that a high-fidelity program reduces hospitalizations by about 58% over 1 year if the alternative involves some type of case management and by 78% if it does not. ACT appears to increase the proportion of clients who live in independent housing situations, but the effect on use of supervised housing, and therefore on housing costs, is ambiguous. The effects on use of most other resources are inconsistent across studies. Overall, ACT appears to result in somewhat lower costs, whatever the perspective of analysis adopted. CONCLUSIONS: The most reliable cost offset to ACT treatment costs appears to be reduced hospital use. Using Quebec costs, an ACT program must enroll people with prior hospital use of about 50 days yearly, on average, to break even. As care systems evolve to reduce their reliance on hospitalization as a care modality with or without ACT, this threshold will become increasingly difficult to achieve. The primary justification for implementing ACT services will then become their clinical benefits.

Canada↗

PubMed1999

Utilization of physician services at the end of life: differences between the United States and Canada.

This study draws on physician claims for the elderly from the U.S. Medicare program and the Canadian provinces of Quebec and British Columbia to compare physician service use by people with fewer than six months to live relative to those who liver longer. Physician service quantities are expressed in relative value units (RVUs), and aggregated into clinical type-of-service categories. Relative to survivors, those in the United States approaching death receive about the same amount of evaluation and management services as those in Quebec and British Columbia, though less in absolute value; they also receive about the same amount of procedures as those nearing death in British Columbia, but half as much in proportion as people nearing death in Quebec. Further analyses of appropriateness of care to the dying appear no less necessary in Canada than in the United States.

Aged↗

PubMed1995

Practice expenses in the MFS (Medicare fee schedule): the service-class approach.

The practice expense component of the Medicare fee schedule (MFS), which is currently based on historical charges and rewards physician procedures at the expense of cognitive services, is due to be changed by January 1, 1998. The Physician Payment Review Commission (PPRC) and others have proposed microcosting direct costs and allocating all indirect costs on a common basis, such as physician time or work plus direct costs. Without altering the treatment of direct costs, the service-class approach disaggregates indirect costs into six practice function costs. The practice function costs are then allocated to classes of services using cost-accounting and statistical methods. This approach would make the practice expense component more resource-based than other proposed alternatives.

Cost Allocation↗

PubMed1992

Physician and practice characteristics, frequency of performance, and the Resource-Based Relative Value Scale.

The Resource-Based Relative Value Scale is based in part on the ratings of the work of services obtained from a random sample of physicians in a specialty. Ratings are used without regard to board-certification or other characteristics of the physician, or to the physician's experience with the service. Critics have suggested that all physicians may not be equally qualified to rate the work of services. Using data obtained from the Resource-Based Relative Value Scale surveys and analyzed using multiple regression methods, the authors found that physician and practice characteristics explain, at most, a small fraction of the variation in ratings of work. Any increase in the precision of the work scale obtained by adjusting physicians' work ratings according to physicians' characteristics could be achieved at lower cost by a slight increase in sample size. Associations between frequency of performing a service and ratings of work are about as likely to be in one direction as another. Most of the differences between estimates of work, excluding and including physicians who have not performed a service, are less than 2% in absolute value, and all are less than 10%. Estimates of work using ratings of physicians in the upper half in frequency of performance are usually within 10% of estimates using other ratings. Even if the observed associations are not due to chance, the potential improvement in accuracy of estimates of work appears too small to justify using data on frequency of performance.

Bias↗

PubMed1992

Incorporating practice costs into the Resource-Based Relative Value Scale.

Practice costs (not including liability insurance costs) account for approximately 41% of the payment for medical and surgical services in the Medicare Fee Schedule. Unlike the portion of the fee schedule that compensates physicians for their work, the practice cost portion of the Medicare Fee Schedule is not resource-based; it is based instead on historical charges. As a result, physicians can recover their practice costs in less time and with less effort (measured in work relative value units) by performing invasive procedures and tests than by providing evaluation and management services. The Physician Payment Review Commission has proposed, in some detail, a method for incorporating practice costs into the Medicare Fee Schedule. The method involves allocating indirect costs on the basis of physician work plus direct costs. We find, using their own analytical framework, that indirect costs should rather be allocated on the basis of time. But to better serve the goal of incentive neutrality, and to make practice cost payments more equitable, the payment a physician receives for practice costs should be based not on service mix and volume, but on characteristics of the physician's practice more closely related to practice costs: for example, whether the physician has an office, or whether the physician practices alone or in a group.

Cost Allocation↗

PubMed1991

Tear of the cervical esophagus following hyperextension from manual traction: case report.

Cervical esophageal disruption is a known complication of hyperextension injuries of the cervical spine. A patient was seen at our institution after nonprofessional manipulation of the cervical spine. There was no apparent cervical spine injury. Following diagnosis, the neck was explored and the esophageal tear repaired and drained. The patient recovered uneventfully.

Adult↗

PubMed1987

Initial effects of the New York State auto safety belt law.

New York State began enforcing a mandatory automobile safety belt use law on January 1, 1985. We present a preliminary analysis of its effect on fatalities and injuries. Applying a Poisson statistical model to pre- and post-law belt usage rates together with counts of fatalities and injuries in 12 metropolitan areas, we estimate the first six months' application of the law averted 220 fatal, 1,500 severe, 4,600 moderate, and 2,600 light injuries across the state. The Poisson approach gives estimates of injuries averted considerably greater than simple year to year comparisons, indicating that media announcements have understated the efficacy of requiring safety belt usage.

Accident Prevention↗