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PubMed1992

Evaluation of community psychiatry: a cross-sectional study.

This study demonstrates a simple epidemiological method to evaluate the changes in service pattern for a defined catchment area after the establishment of a hospital-based community psychiatry service in Denmark. It measures the number of patients in contact with the service on 2 census days, before the new service was introduced and 3 years later, and deals with quantitative measures of sex, age, diagnosis and type of service contact. The services for 2 other areas are used as controls. A new community psychiatry service with an office situated outside the hospital is described and is shown to be superior to both the psychiatry service from the hospital and the rest of the hospital service: the number of inpatients and day patients were reduced by 42% vs 12% and 16% respectively. The number of outpatients increased by 104% in the new service compared with 23% for the service located at the hospital. The increase in outpatient care for the service outside the hospital was mainly caused by contact with middle-aged women with personality disorders.

Adult↗
PubMed1996

Preparing for the new outpatient reimbursement system.

The Health Care Financing Administration is expected to soon introduce a prospective payment method for reimbursement of hospital-based outpatient services provided to Medicare recipients. This payment system most likely will make use of an outpatient classification system based on ambulatory patient groups (APGs). Although the details of the new ambulatory payment system have not yet been finalized, healthcare facilities should start planning for implementation.

Ambulatory Care↗
PubMed2003

Healthcare use by veterans treated for diabetes mellitus in the Veterans Affairs medical care system.

OBJECTIVES: To estimate the burden of comorbid conditions and to describe patterns of inpatient and outpatient service use by veterans with diabetes mellitus. STUDY DESIGN: Retrospective cohort study of 33,481 veterans conducted by means of secondary analysis of Department of Veterans Affairs (VA) healthcare utilization databases. PATIENTS AND METHODS: The cohort was constructed by enrolling all veterans treated in the VA medical care system who had their initial VA hospitalization for diabetes mellitus between 1992 and 1997. To estimate the typical annual pattern of service use for diabetes mellitus, 1997 utilization rates per person-year were analyzed based on cohort members surviving into 1997. Data on comorbid conditions were obtained from outpatient and inpatient contacts. RESULTS: The 3 most prevalent coexisting conditions were hypertension (73.4%), ischemic heart disease (35.2%), and alcohol or drug abuse disorders (29.5%). In 1997, the typical cohort member followed for 12 months had 6 primary care visits, 16 other visits for tests or consultations, and 1.3 unscheduled visits for emergency or urgent care and spent approximately 8 days in the hospital. One-year survival was 94.0%. CONCLUSIONS: In the VA medical care system, beneficiaries with diabetes mellitus have an extremely heavy burden of comorbidities, face a significant risk of dying in a given year (approximately 6% in this population), and are heavy users of hospital and outpatient services.

Adult↗