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Biomedical subjects

L I Sederer

Publications and source records attributed to L I Sederer.

33 records · Page 2Linked to original sources
PubMed1990

Quality assurance and managed mental health care.

Quality assurance demands that health professionals meet the timeless mandate of helping (when we can) and doing no harm. The delivery of quality care has been profoundly influenced by systems of managed care, which may represent the principal trend in organized medicine in the 1980s. This chapter first defines quality and quality assurance. We then define managed care and managed mental health care. The implications of managed care on patients and health professionals are then addressed. Finally, we discuss examples of what has been done and what can be done to help ensure the continued provision of quality care in a cost-conscious society.

Delivery of Health Care↗
PubMed1989

Managed health care and the Massachusetts experience.

Managed health care, through prepaid health delivery systems and utilization review organizations, is perhaps the greatest trend in modern health care. The authors examine the remarkable growth of managed care and outline its clinical, economic, ethical, and practical implications. They then review examples of how organized psychiatry has been involved in managed care and describe the efforts to date of the Massachusetts Psychiatric Society in this area. Managed care is here to stay. The future climate of psychiatric practice and the care available to psychiatric patients are dependent on informed and organized activities by psychiatrists and their local and national representatives.

Delivery of Health Care↗
PubMed1987

Utilization review and quality assurance: staying in the black and working with the blues.

Utilization review (UR), Quality Assurance (QA), and Peer Review (PR) have become essential aspects in the practice of general hospital psychiatry. This article first defines and elaborates the basic elements of UR, QA, and PR and then outlines the development of a program for these professionally initiated and maintained methods of problem seeking and solving as it occurred on a short-term voluntary inpatient psychiatric unit. Finally, current trends and conflicts inherent to QA, UR, and PR are discussed, with a view towards the future.

Cost Control↗
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

Psychiatric expertise in clinical decision making for psychiatric inpatients.

Hospital boards and medical staffs are faced with difficult decisions about whether nonphysician mental health professionals should be given admitting privileges to psychiatric hospitals or treatment units. The authors describe the special medical expertise of the psychiatrist and define 11 indicators, such as a patient's need for new psychotropic medication or the presence of symptoms requiring medical or laboratory procedures, that can be used to determine whether psychiatric expertise is needed. The indicators were applied to a group of ten patients who constituted all admissions to a treatment unit in a private, nonprofit psychiatric hospital in a one-month period. At least half of the indicators were relevant to all the patients studied, suggesting the need for management by a psychiatrist.

Clinical Competence↗
PubMed1986

First do no harm: short-term inpatient psychotherapy of the borderline patient.

Patients with borderline personality disorder typically are hospitalized in the midst of a crisis and in a state of acute regression. After a few days in which the patient is provided with containment and support, the therapist can assess whether the patient has the capacity for exploratory psychotherapy that may help in ego development or whether such psychotherapy may prompt further regression and dangerous acting out. For exploratory therapy certain conditions, such as an observing ego, a therapeutic alliance, and the therapist's ability to contain countertransference feelings and deal with the patient's projections, are essential. The therapist must be alert to common treatment errors that can undermine the patient's capacity to recompensate; they are likely to occur in the areas of empathy, confrontation, transference, interpretation and management, and the patient's attachment to pain.

Adult↗
PubMed1986

Inpatient psychosocial treatment of chronic schizophrenia: negative effects and current guidelines.

In the inpatient psychosocial treatment of schizophrenia, therapies that are intense and overstimulating often promote or prolong regression and negatively affect long-term adjustment. These approaches fail to take into account the chronicity of the disorder, the special vulnerabilities of the schizophrenic patient, and the appropriate goals of an inpatient admission. Based on a review of these problems, the authors offer several prescriptions for inpatient psychotherapy of schizophrenia: modest, well-defined goals; gentle, supportive, educational interactions with the patient; inclusion of the patient's support system and outpatient caregivers in the treatment; and attention to long-term adjustment as well as to short-term symptom removal.

Chronic Disease↗
PubMed1984

Inpatient psychiatry: perspectives from the general, the private, and the state hospital.

Although it is widely recognized that inpatient psychiatry is different as it is practiced in the general, private, and state hospital, why and how it is different have not been clearly articulated. In this paper, the directors of inpatient units in a general hospital, a private hospital, and a state hospital first provide an analysis of how the history and the organizational structures of these units have shaped their identity. The authors then specifically detail the different patient populations, referral sources, financial bases, leadership arrangements, milieu philosophies, research and training activities, and lengths of stay on these units. Finally, on the basis of the reality and the value of different inpatient settings, a view toward the future of inpatient psychiatry is offered.

Community Mental Health Centers↗
PubMed1981

Should general hospitals accept involuntary psychiatric patients? A panel discussion.

The issue of whether involuntary patients can be treated safely and effectively on inpatient psychiatry units of general hospitals is addressed from several points of view. Parallels are drawn between contemporary reform efforts and 19th century hospital psychiatry, and the danger of repeating errors of the past is pointed out. An account follows, illustrating the recent planning process for mental health care in Massachusetts and recommending the active participation of psychiatrists in that process. Also discussed are the differences in the process of establishing a treatment alliance with voluntary and involuntary patients. The practical considerations in the development of a locked unit in a general hospital area explored, with respect to its effect on reimbursement, the private practice model, and the length and appropriateness of stay. In conclusion, the shared concern is stated that, in respect to making the transition from one system of care to another, safeguards be built in to protect and expand good treatment.

Commitment of Persons with Psychiatric Disorders↗
PubMed1979

A family myth: sex therapy gone awry.

The treatment of sexual disorders has achieved considerable popularity and respectability within the mental health profession and the lay community. As a consequence, it has become increasingly difficult to elude requests for this type of treatment and even more difficult to balance sexual concerns with the numerous other modes of relating that exist within a dyadic relationship. This paper will report two versions of a case study in which sexual dysfunction served as a myth that was carefully constructed to veil certain more fundamental problems.

Adult↗
PubMedDate not supplied

Managing suicidal inpatients.

Suicidality is the most common and vexing challenge presented by psychiatric inpatients. Although clinicians' ability to predict suicide is limited and suicide may inevitably occur, conscientious assessment of risk, effective distinction among various characteristics of the suicidal crisis, and thoughtful policies and procedures will help keep many patients from fatal outcomes.

Humans↗
PubMedDate not supplied

Mental health services reform in Japan.

Economic and social pressures are driving Japan to reform its mental health services. Traditionally, psychiatric services in Japan have been custodial. Reimbursement has been principally fee-for-service, with incentives that encourage hospital-based care. Reform measures are beginning to promote the concept of "normalization," in which the mentally ill are seen to be disabled, like persons with physical disabilities. New practices including deinstitutionalization, differentiation of services, revisions in payment, and quality assessment are being introduced. This article provides an overview of the current status of Japanese mental health services, summarizes policy dilemmas, and identifies priority areas for intervention.

Adolescent↗