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PubMed2005

Service use and outcomes of first-admission patients with psychotic disorders in the Suffolk County Mental Health Project.

OBJECTIVE: The purpose of the study was to examine the inpatient and outpatient service use and 4-year outcomes of newly admitted psychotic patients during a period of rapid change in the provision of psychiatric services in a well-defined catchment area in New York State in the 1990s. METHOD: Subjects were 573 participants of the Suffolk County Mental Health Project. This group comprised patients with psychotic disorders first admitted between September 1989 and August 1995 to 12 inpatient facilities across Suffolk County, N.Y., and followed for up to 48 months. The subjects' service use, course of illness, symptomatic outcomes, suicide risk, homelessness risk, and satisfaction with care were compared across admission years. RESULTS: The length of inpatient stays decreased significantly across the years. However, the number of outpatient visits and therapy sessions did not vary. Although the patients admitted in later years were more symptomatic at admission to their first hospitalization, their course and outcomes over the follow-up period were not worse and they were not less satisfied with their care, compared with the patients admitted in earlier years. CONCLUSIONS: The clinical characteristics of patients and the role of inpatient care in the management of patients with psychotic disorders gradually changed during the 1990s. These changes, however, were not associated with changes in the use of outpatient services or outcomes. Nevertheless, shorter hospital stays and the presence of more severely ill patients highlight the need for more attention to linkage to aftercare and enhancement of support networks in the community.

Adult↗
PubMed2006

Medicare program; hospital outpatient prospective payment system and CY 2007 payment rates; CY 2007 update to the ambulatory surgical center covered procedures list; Medicare administrative contractors; and reporting hospital quality data for FY 2008 inpatient prospective payment system annual payment update program--HCAHPS survey, SCIP, and mortality. Final rule with comment period and final rule.

This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system, and to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and the Deficit Reduction Act (DRA) of 2005. In this final rule with comment period, we describe changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2007. In addition, this final rule with comment period implements future CY 2009 required reporting on quality measures for hospital outpatient services paid under the prospective payment system. This final rule with comment period revises the current list of procedures that are covered when furnished in a Medicare-approved ambulatory surgical center (ASC), which are applicable to services furnished on or after January 1, 2007. This final rule with comment period revises the emergency medical screening requirements for critical access hospitals (CAHs). This final rule with comment period supports implementation of a restructuring of the contracting entities responsibilities and functions that support the adjudication of Medicare fee-for-service (FFS) claims. This restructuring is directed by section 1874A of the Act, as added by section 911 of the MMA. The prior separate Medicare intermediary and Medicare carrier contracting authorities under Title XVIII of the Act have been replaced with the Medicare Administrative Contractor (MAC) authority. This final rule continues to implement the requirements of the DRA that require that we expand the "starter set" of 10 quality measures that we used in FY 2005 and FY 2006 for the hospital inpatient prospective payment system (IPPS) Reporting Hospital Quality Data for the Annual Payment Update (RHQDAPU) program. We began to adopt expanded measures effective for payments beginning in FY 2007. In this rule, we are finalizing additional quality measures for the expanded set of measures for FY 2008 payment purposes. These measures include the HCAHPS survey, as well as Surgical Care Improvement Project (SCIP, formerly Surgical Infection Prevention (SIP)), and Mortality quality measures.

Forms and Records Control↗
PubMed2004

The influence of the patients' ethnicity, socio-demographic conditions and strain on psychiatric diagnoses given at an outpatient clinic.

Although psychiatric diagnoses are influenced by cultural and social conditions, with large global variations, the ICD and DSM systems are applied worldwide. The aims of this study were to describe the distribution of different ethnic patient groups in psychiatric outpatient services and the influence of ethnicity, demographic conditions and social strain on psychiatric diagnoses. An entire year's cohort of psychiatric outpatients (n = 839) in an outpatient register was divided into nine groups, according to country of birth. The proportion of each group in the outpatient population was compared with its corresponding proportion in the catchment area. In order to examine the relationship between socio-demographic variables and strain on the one hand, and DSM-III-R diagnoses on the other, stepwise logistic regression analyses were carried out. Swedes were the only group under-represented as outpatients (P < 0.001). Africans ran a higher risk (OR = 5.55, 95% CI = 2.56-12.04) than other ethnic groups of receiving a diagnosis of psychotic disorder--except schizophrenia--and Greek patients were more likely to receive a diagnosis of somatoform disorder (OR = 8.81, 95% CI = 4.41-17.59). Swedes were twice as likely to receive a diagnosis of personality disorder (OR = 2.16, 95% CI = 1.55-3.15). Schizophrenia was related to male gender (OR = 1.75, 95% CI = 1.04-2.94) and affective disorders to age >40 years (OR = 1.71, 95% CI = 1.22-2.40). Ethnicity has a strong impact on how diagnoses are given in cross-cultural settings. We could not confirm earlier findings of under-representation of ethnic minorities in outpatient services.

Adolescent↗
PubMed1989

Medicaid policy and the substitution of hospital outpatient care for physician care.

This article explores the effects of reimbursement and utilization control policies on utilization patterns and spending for physician and hospital outpatient services under state Medicaid programs. The empirical work shows a negative relationship between the level of Medicaid physician fees relative to Medicare and private fees, and the numbers of outpatient care recipients, suggesting that outpatient care substitutes for physician care in states with low fee levels. In addition, it shows a positive relationship between Medicaid physician fees and outpatient spending per recipient, suggesting that in low-fee states outpatient departments are providing some types of care that could be provided in a physician's office. Finally, the analysis demonstrates that reimbursement and utilization control policies have significant effects in the expected directions on aggregate Medicaid spending for physician and outpatient services.

Ambulatory Care↗
PubMed2004

Use of psychiatric and medical health care by veterans with severe mental illness.

Risk behaviors and health care use among 396 initially hospitalized veterans with severe mental illnesses were examined. Health care use was abstracted from Veterans Affairs databases (March 1998 to June 2000) for one year after hospital discharge. Lifetime intravenous drug use was related to increased use of outpatient services, and current alcohol use was related to decreased health care use. Patients with posttraumatic stress disorder had greater use of medical outpatient services than patients with schizophrenia-spectrum disorders, although they had longer hospital stays. These results highlight that veterans with severe mental illness receive more treatment in medical than psychiatric health clinics.

HIV Infections↗
PubMed1992

[Cancer rehabilitation in the Federal Republic of Germany--a critical review from the perspective of rehabilitation psychology].

Against the background of a common criticism of the rehabilitation system, the situation of rehabilitation research and practice in oncology is reviewed. A lack of efforts aimed at vocational rehabilitation as well as the main emphasis in inpatient services is criticized. Till now, outpatient services as well as psychosocial rehabilitation care are not as well established, as they should be with regard to provide assistance in coping with the disease and in adapting to the various disabilities may be followed by cancer. As rehabilitation research in oncology is still at its very beginning, we know little about the acceptance of rehabilitation measures as well as the rehabilitation process in its correlation between outcome criteria. Our own pilot study provides first results concerning vocational rehabilitation and acceptance of medical rehabilitation services. As conclusion, we need more elaborated research in oncological rehabilitation for optimizing and further developing rehabilitation care system especially with respect to outpatient and psychosocial services.

Ambulatory Care↗
PubMed1991

Home health, diagnostic centers were financial winners in 1990.

The importance of outpatient services to hospitals' total net patients revenues continues to increase steadily. In fact, nearly one-third of those participating in our fourth annual survey on diversification gauged outpatient services as providing 30 percent or more of their total net patient revenues in 1990.

Data Collection↗
PubMedDate not supplied

[Simulation modeling of polyclinic service processes].

An approach to the construction of the model imitating the processes of servicing the population in outpatient clinics is discussed. The algorithm describing the formation of queues before different reception rooms in the outpatient clinic is devised. The approximation of the patient waiting time functional is proposed, and the hypothesis of its convexity in the space of the functions connecting the properties of the structural elements of the outpatient service with the cost of their technical equipment is put forward. The problem on the optimization of the technical equipment of the services and reception rooms of the outpatient clinic under the conditions of the limited total amount of these costs is defined.

Ambulatory Care↗
PubMed1999

Impact of uracil/tegafur plus oral calcium folinate on resource utilization.

Data from a multinational phase III trial were analyzed to evaluate the use of in- and outpatient services for 373 patients with metastatic colorectal cancer being administered uracil/tegafur (in a molar ratio of 4:1 [UFT]) plus oral calcium folinate (Orzel) (N = 188) vs 5-fluorouracil (5-FU) plus oral calcium folinate (N = 185). Hospital and/or nursing home admissions were studied, including hospitalizations for febrile neutropenia, infection, tumor progression, drug toxicity, and transfusion. Chemotherapy hospitalization data were not collected. Analyzed outpatient services included family doctor, hospital, private nurse, physiotherapist, and home-help visits. Results showed that UFT plus oral calcium folinate may be associated with reductions in the use of inpatient services and work loss due to illness among patients with metastatic colorectal cancer.

Administration, Oral↗
PubMed1997

Problems in counting and paying for multidisciplinary outpatient clinics.

Policy-makers have always found it problematic to formulate fair and consistent counting rules for public hospital outpatient activities. In the context of output-based funding, such rules have consequences which can affect patient care. This paper reviews the rationale for organising multidisciplinary clinics and reports on a series of focus groups convened in four Melbourne teaching hospitals to consider funding policy for such clinics. It discusses issues of targeting outpatient services, along with implications for payment policy. It evaluates counting rules in terms of intended and unintended consequences in the context of Victoria's introduction of output-based funding for outpatient services.

Accounting↗
PubMed1997

[Outpatient neurological services. A descriptive analysis of a consultation clinic in Baix Llobregat].

INTRODUCTION: Attention to the public, outside the hospital, in the specialty of neurology has recently been separated from psychiatry. OBJECTIVE: We have evaluated the functioning of a neurology outpatient clinic from the point of view of the clinical, diagnostic and therapeutic aspects and the demand for such attention. MATERIAL AND METHODS: The region studied was the Baix Llobregat Nord, in the province of Barcelona. The total population is 174,429 inhabitants. The sample was of 592 patients who requested a first consultation between June and December 1996. RESULTS: There was a predominance of women (57.7%). The average age was 45.1. The general practitioner referred 86.3% of the patients. Complementary tests were requested in 51% of the patients. CT was the investigation most commonly requested (18.5%), followed by the EEG (12.3%). Considering the diagnostic groups: headache made up 31.4%, followed by vertigos, psychiatric disorders, cerebral vascular pathology, epilepsy and dementia. Treatment was given to 41% of the patients (247). The commonest drugs used were calcium antagonists (26%), analgesics (16.4%), tranquillizers, and muscle relaxants (11.1%), anti-depressives (9.9%), platelet antiaggregants (9.9%). There was 86.6% correct derivation and 75% concordance with the derivant. CONCLUSIONS: The average demand per 100 inhabitants per year was 7.6 with significant differences depending on the organization of the area health services. The considerable number of patients with psychiatric pathology (9.4%) was noticeable. Better selection of the patients referred to the neurologist would enable the quality of care available to be improved.

Adult↗