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PubMed1999

Patient readmission and support utilization following anterior temporal lobectomy.

The aim of this study was to examine factors precipitating patient readmission, following anterior temporal lobectomy (ATL) for refractory epilepsy. A second aim was to explore the use of hospital outpatient and community support services ('outpatient services') by this patient population. These aims served the more general goal of identifying patients most likely in need of services additional to those routinely provided by our Seizure Surgery Follow-up and Rehabilitation Programme. The medical records of 100 consecutive ATL patients were retrospectively examined for the incidence and diagnoses precipitating acute readmission, and the utilization of additional outpatient services. Twenty-one patients (21%) required readmission post-ATL, totalling 47 readmissions between them. Psychiatric diagnoses were the most prevalent (53%), including anxiety, depression and/or post-ictal psychosis. Epileptological diagnoses were the other main precipitant (28%). Additional outpatient services were predominantly utilized for ongoing psychological support. Of the 21 patients requiring readmission, 10(10%) also needed additional outpatient services. These patients were predominantly female or unemployed, in contrast to male or employed patients who tended to require readmission only. Seventeen patients (17%) were maintained within the community using additional outpatient services only. Characteristics of these patients included disrupted family dynamics, limited social networks, and/or a psychiatric history. These patients were also more frequently beyond the 24-month follow-up period of the programme. A profile of patients most in need of additional support services can be constructed to assist team planning of proactive management strategies for the rehabilitation phase of ATL.

Acute Disease↗
PubMed2006

Recent treatment history vs clinical characteristics in the prediction of use of outpatient psychiatric services.

BACKGROUND: The use of outpatient psychiatric services has been shown to be a complex function of sociodemographic, clinical, and pathway variables. The relative contribution of each variable or groups of variables in explaining the variability in the use of outpatient psychiatric services, however, remains poorly documented. METHODS: The subjects (N=382) were all patients admitted to an outpatient psychiatric clinic serving mostly a minority and low-income population. The charts of the patients were reviewed for sociodemographic, clinical, and pathway variables and the number of outpatient visits. The pathway variables studied were source of referral and most recent psychiatric treatment service used. Both bivariate and multivariate statistics were used to analyze the data. RESULTS: Pathway variables were better predictors of the number of outpatient visits than clinical variables after controlling for sociodemographic variables. CONCLUSION: Patients recently hospitalized may be sicker or have fewer social supports and therefore require more outpatient visits. Recent treatment history stands out as an important variable in the prediction of the number of outpatient mental health visits. More research is needed to examine the influence of pathway variables on treatment decisions.

Adult↗
PubMed2001

Medicaid program; revision to Medicaid upper payment limit requirements for hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. Health Care Financing Administration (HCFA), HHS. Final rule.

This final rule modifies the Medicaid upper payment limits for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. For each type of Medicaid inpatient service, existing regulations place an upper limit on overall aggregate payments to all facilities and a separate aggregate upper limit on payments made to State-operated facilities. This final rule establishes an aggregate upper limit that applies to payments made to government facilities that are not State government-owned or operated, and a separate aggregate upper limit on payments made to privately-owned and operated facilities. This rule also eliminates the overall aggregate upper limit that had applied to these services. With respect to outpatient hospital and clinic services, this final rule establishes an aggregate upper limit on payments made to State government-owned or operated facilities, an aggregate upper limit on payments made to government facilities that are not State government-owned or operated, and an aggregate upper limit on payments made to privately-owned and operated facilities. These separate upper limits are necessary to ensure State Medicaid payment systems promote economy and efficiency. We are allowing a higher upper limit for payment to non-State public hospitals to recognize the higher costs of inpatient and outpatient services in public hospitals. In addition, to ensure continued beneficiary access to care and the ability of States to adjust to the changes in the upper payment limits, the final rule includes a transition period for States with approved rate enhancement State plan amendments.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2000

The role of daclizumab in balancing resources for inpatient and outpatient transplant services.

Transplant professionals have the dual responsibility of achieving acceptable clinical outcomes and controlling costs. One approach transplant centers have used to control transplant-related costs has been to decrease patients' length of stay, and thus it has decreased significantly in the last 6 years. This reduction in resource consumption has been accomplished by increased efficiency in providing transplantation services, expanding the number of outpatient services available, and integrating new technologies. Future cost containment measures by payers, especially Medicare, will continue to require that transplant centers manage resources and meet financial objectives while achieving acceptable clinical outcomes. Daclizumab, a new immunosuppressive drug, is used as an example in this article, which assesses its value in helping meet resource management and financial goals.

Antibodies, Monoclonal↗
PubMed2007

Quality improvement and its impact on the use and equality of outpatient health services in India.

This paper examines the impact of quality improvements in conjunction with user fees on the utilization and equality of outpatient services at a range of public sector health facilities in India. Project impact on outpatient visits was estimated via the difference-in-difference method using pooled time series visit data from project and control facilities. The results indicate that the quality improvements significantly increased visits at all facility types. The project effect was largest at primary health center (PHC) and community health center (CHC), followed by district hospital (DH) and female district hospital (FDH). Pro-rich inequalities in outpatient visits increased at DHs and FDHs while at CHCs and PHCs the distribution remained equitable. This suggests that quality improvements at public sector health facilities can increase utilization of outpatient services in the presence of nominal user fees, but can also promote greater inequality favoring the better-off. At the referral hospital level, quality improvements should be made in conjuction with programs which encourage utilization by the poor. In contrast, the benefit of quality improvements at PHCs and CHCs is equitably distributed.

Ambulatory Care↗
PubMed1996

Diabetes mellitus and health service utilization: a case-control study of outpatient visits 8 years after diagnosis.

All incident cases of diabetes mellitus in the age group 15 to 34 years have been prospectively registered in Sweden since January 1983. To analyse the utilization of outpatient services 8 years after disease onset, we selected the cases registered in 1983 and two controls per case from the general population, matched by age, gender, and county of residence. In 1991, retrospective data about utilization patterns during a 3-month period were collected via a mailed questionnaire, returned by 317 (72%) patients with diabetes and 586 (68%) controls. Seventy-four percent of the cases and 19% of the controls reported at least one visit to a hospital outpatient clinic, including accident and emergency departments. The odds ratio for one visit was 14 (95% CI 9.6-20), for two visits 11 (95% CI 7.0-18), and for three or more visits 8.9 (95% CI 5.6-14). Even when specialized diabetes clinics were excluded from the analysis, the cases had higher odds for visits to internal medicine clinics, to ophthalmology clinics, and to gynaecology clinics, but not for visits to surgical clinics or to accident and emergency departments. Of non-hospital outpatient services, only visits to nurse practitioners were reported by a higher percentage of diabetic responders. Twenty-seven percent of patients with diabetes, as compared to 9% of the controls, had visited both hospital and non-hospital outpatient offices. Females were overrepresented among diabetic high-consumers. The results indicate that most young to middle-aged Swedish persons with diabetes are monitored at hospital outpatient offices, but considerable overlap exists between hospital and non-hospital outpatient services. Further research is needed into the determinants of utilization patterns in diabetes, such as gender.

Adolescent↗
PubMed1988

Inpatient and outpatient psychiatric services: substitutes or complements?

Patients at risk for psychiatric hospitalization make only limited use of outpatient services, although clinical research has demonstrated that outpatient treatments and home care can be as effective as inpatient psychiatric treatment in treating certain mental health problems. The substitution of ambulatory services for inpatient care has in part been limited because insurers have restricted outpatient mental health benefits to control utilization. The authors critically review evidence from the economic and clinical literatures to determine the extent to which outpatient psychiatric treatment substitutes or complements inpatient treatment. To encourage clinically effective substitution of outpatient for inpatient services, further research is needed to identify the patient populations for whom substitution is possible and the treatment and environmental conditions in which it is most likely to be successful.

Ambulatory Care↗
PubMed1982

Patient satisfaction with outpatient pharmaceutical services.

Patient characteristics and satisfaction with outpatient pharmaceutical services at a large university hospital were assessed. A mail questionnaire was sent to 700 outpatients selected at random. Most questions had fixed-format answers. Of the 388 (58%) returned surveys, 335 (50%) were usable. A large segment of the respondents (40%) were between the ages of 18 and 34. Fifty-nine percent of the respondents paid for their own prescriptions, and this group was less likely to fill their prescriptions at the university pharmacy. Of the patients who received prescriptions but did not have them filled at the university, 29% were unaware of the existence of the pharmacy, 36% found the pharmacy inconvenient for refills, and 21% thought that the waiting time to get their prescriptions filled was too long. Of the respondents who received prescriptions, 46% ahd them filled at the university pharmacy. Convenience (55%), availability of medications (19%), and low prices (12%) were the major reasons given for going to the university pharmacy. No association was found between the distance from the university and the internal retention rate for prescriptions. Of those who went to the university pharmacy, 94% were satisfied with the services they received.

Consumer Behavior↗
PubMed1981

Outpatient pharmaceutical services in academically affiliated hospitals and selected community hospitals.

The outpatient pharmaceutical services provided by university or medical school-affiliated hospitals and those offered by community hospitals were compared. A questionnaire was sent to a sampling of hospitals that had full-time pharmaceutical services. The hospital pharmacists were asked how frequently they performed 13 patient-oriented services. Four hundred community hospitals from 13 western states and 95 university hospitals nationwide were surveyed. The four null hypotheses tested were: (I) There is no difference between university and community hospitals in mean frequency of patient-oriented pharmaceutical services; (II) the mean frequencies of patient-oriented services are independent of hospital bed capacity; (III) the mean frequencies of patient-oriented services are independent of whether or not clinic outpatients are served by the outpatient pharmacy; and (IV) the mean frequencies of patient-oriented services are independent of the number of full-time equivalent pharmacists employed by the pharmacy. Performance of the 13 patient-oriented services was almost parallel for both the university and community hospitals. The only service that demonstrated a significant difference (p less than 0.05) between the two groups was "prescribing and renewing medication at the request of the physician." The most frequently performed services were to give patients oral medication instructions and drug information for the medical staff. Null hypothesis I was not rejected. A four-way analysis of variance was performed on null hypotheses II, III, and IV; II and III were rejected (alpha less than or equal to 0.05). Nevertheless, a one-way analysis of variance, post-hoc test, and t test revealed that the performance of patient-oriented services was more frequent in hospitals with less than 100 beds and in hospitals that provided outpatient services to clinic patients. Null hypothesis IV was not rejected.

Hospitals, Community↗
PubMed1991

Psychiatric outpatient care services in mental health organizations, United States, 1986.

In 1986, 2,967 mental health organizations, or 62 percent of all mental health organizations in the United States (including territories), offered psychiatric outpatient care services. A total of 5.6 million patient care episodes were provided by these organized outpatient services. These episodes involved a total of 47 million visits and 2.8 million additions, and represented 69 percent of all psychiatric patient care episodes in organized settings that year. Both the number of organizations with psychiatric outpatient care services and the number of outpatient additions to these organizations increased by approximately 4 percent between 1983-84 and 1986. Multiservice mental health organizations were the most prominent type of mental health organization in the provision of psychiatric outpatient care. They comprised 42 percent of the 2,967 organizations offering this type of care and were responsible for 54 percent of the outpatient additions, 53 percent of the episodes, and 54 percent of the visits. Next in importance were freestanding psychiatric outpatient clinics and separate psychiatric services in non-Federal general hospitals. They accounted for 26 percent and 17 percent, respectively, of organizations providing psychiatric outpatient care. Each provided 12 to 18 percent of outpatient additions, episodes, and visits. Over 90 percent of multiservice mental health organizations and Veterans Administration psychiatric organizations offered outpatient psychiatric care. In contrast, this form of care was offered by only 29 percent of State and county mental hospitals, 36 percent of private psychiatric hospitals, 37 percent of nonFederal general hospitals with psychiatric services, and 23 percent of residential treatment centers for emotionally disturbed children.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Outpatient dental services for individuals with mental illness: a program description.

This paper describes a state-funded program providing dental services for community-based mentally ill clients. Contrasts between outpatient services for persons with mental illness and similar programs serving the mentally retarded population are emphasized. Implications of client eligibility, communication, and compliance issues relative to limitations of care are discussed. Suggestions for improving similar programs are provided.

Ambulatory Care Facilities↗
PubMed1996

Parent satisfaction with children's mental health services in a children's mental health managed care demonstration.

This article presents findings from a quasi-experiment that included the use of satisfaction scales to compare parent's satisfaction with the services their children received through two different mental health care delivery systems. Satisfaction with the following three types of service were compared: (1) intake assessment during the admission process to any service setting, (2) outpatient services, and (3) residential treatment including inpatient hospitalization and residential treatment centers (RTCs). Additionally, satisfaction with several areas of care (e.g., access, treatment process, therapist relationship, parent and family services, discharge and transition planning), as well as global satisfaction, was assessed. In general, parents whose children received services through an innovative continuum of care system reported significantly higher satisfaction with intake assessment and outpatient services than did parents whose children received care in a traditional fee-for-service system. Fewer differences were found in satisfaction with residential services.

Adolescent↗
PubMed1987

Cocaine dependence treatment on an inpatient detoxification unit.

A psychoanalytic-developmental treatment model includes individual and group psychotherapy which enables compulsive freebase cocaine smokers to articulate explanations for their drug dependence. Relapse prevention education includes recommendations for aftercare treatment. Psychosocial history and DSM-III diagnostic data (N = 31) reveals histories of dysfunctional family dynamics, high rates of depressive disorders, and personality disorders. A case history illustrates application of our treatment model and problems in currently available post-detox treatment. Residential therapeutic communities (TCs) need to offer variable program lengths and specialized crack residences in therapeutic milieus with trained clinical staff. TC programs should offer inpatient psychotherapy, family therapy, and provide direct entrance into program affiliated outpatient services. Recommendations for outpatient services include adjuncts to established anonymous self-help group networks in order to reduce changes of relapse.

Adolescent↗
PubMed2004

Health literacy and use of outpatient physician services by Medicare managed care enrollees.

OBJECTIVE: To determine whether inadequate functional health literacy adversely affects use of physician outpatient services. DESIGN: Cohort study. SETTING: Community. PARTICIPANTS: New Medicare managed care enrollees age 65 or older in 4 U.S. cities (N = 3,260). MEASUREMENTS AND MAIN RESULTS: We measured functional health literacy using the Short Test of Functional Health Literacy in Adults. Administrative data were used to determine the time to first physician visit and the total number of visits during the 12 months after enrollment. The time until first visit, the proportion without any visit, and adjusted mean visits during the year after enrollment were unrelated to health literacy in crude and multivariate analyses. Participants with inadequate and marginal health literacy were more likely to have an emergency department (ED) visit than those with adequate health literacy (30.4%, 27.6%, and 21.8%, respectively; P =.01 and P <.001, respectively). In multivariate analysis, the adjusted relative risk of having 2 or more ED visits was 1.44 (95% confidence interval, 1.01 to 2.02) for enrollees with marginal health literacy and 1.34 (1.00 to 1.79) for those with inadequate health literacy compared to participants with adequate health literacy. CONCLUSIONS: Inadequate health literacy was not independently associated with the mean number of visits or the time to a first visit. This suggests that inadequate literacy is not a major barrier to accessing outpatient health care. Nevertheless, the higher rates of ED use by persons with low literacy may be caused by real or perceived barriers to using their usual source of outpatient care.

Aged↗
PubMed1988

Medicare program; changes to the return on equity capital provisions for outpatient hospital services--HCFA. Final rule.

We are revising the Medicare regulations to eliminate the allowance for a return on equity capital for outpatient services furnished by proprietary hospitals as required by section 4065 of the Omnibus Budget Reconciliation Act of 1987 (enacted on December 22, 1987). Section 4065 prohibits recognition of any return on equity capital with respect to hospital outpatient departments effective January 1, 1988.

Aged↗