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PubMed1990

[Compliance and long-term prognosis in hypertensive patients. Case series in a specialized hospital outpatient service].

In this study of ambulatory patients who had their first visit at the hypertension Unit of the Ospedale San Carlo Borromeo in Milan during the years 1979-1983, we report some data regarding compliance and long-term prognosis of mild hypertension. In these 5 years, 445 mild hypertensives (mean DBP: 103.3 +/- 13.2 mmHg) came to our facilities at least once: of these, 57 (12.9%) have been in constant touch with the outpatient clinic until today; 310 (69.6%) have been lost to follow-up after less than 1 year; 78 (17.5%) had an irregular pattern of attendance with a mean length of follow-up of 3.49 +/- 1.8 years. These data indicate a less than ideal compliance especially for patients who were older, smokers, not married and with no previous pharmacological treatment at the first visit. Index of morbidity and mortality for all causes and for cardiovascular disease and blood pressure control were better, although without reaching statistical significance, in the 57 patients with the best compliance. Altogether our data point to a reevaluation of the approach to the problem of mild hypertension through specialised hospital facilities.

Adult↗
PubMed2002

Medicare's fee schedule for hospital outpatient care.

Medicare's hospital outpatient prospective payment system (OPPS) went live on August 1, 2000, after a decade of developmental work. The new system introduced a fee schedule that replaced the cost-related methods that Medicare previously used to reimburse various hospital outpatient services. Hospitals are now paid predetermined rates or fees based on the Ambulatory Patient Classification (APC) groups assigned to the services that Medicare patients receive during outpatient encounters. The new system aims to simplify Medicare's intricate cost-based reimbursement policies, improve hospital efficiency, ensure that payments are sufficient to compensate hospitals for reasonable Medicare costs, and reduce Medicare coinsurance amounts for beneficiaries. Implementation of OPPS-related administrative and operational changes has been a major challenge for hospitals.

Accounting↗
PubMed1997

A national estimate of the economic costs of asthma.

This cost of illness analysis examines national cost and resource utilization by persons with asthma using a single, comprehensive data source, the 1987 National Medical Expenditure Survey. Direct medical expenditures included payments for ambulatory care visits, hospital outpatient services, hospital inpatient stays, emergency department visits, physician and facility payments, and prescribed medicines. Indirect medical costs included costs resulting from missed work or school and days with restricted activity at work. Point estimates and 95% confidence intervals (CI) were calculated and inflated to 1994 dollars. The total estimated cost was $5.8 billion (95% CI, $3.6 to $8 billion). The estimated direct expenditures were $5.1 billion (95% CI, $3.3 to $7.0 billion), and indirect expenditures were valued at $673 million (95% CI, $271 to $1,076 million). Hospitalization accounted for more than half of all expenditures. More than 80% of resources were used by 20% of the population (defined as 'high-cost patients'). The estimated annual per patient cost for those high-cost patients was $2,584, in contrast with $140 for the rest of the sample. Findings from this study indicate that future asthma research and intervention efforts directed at hospitalizations and high-cost patients could help to decrease health care resource use and provide cost savings.

Absenteeism↗
PubMed1993

[Determinants of patient satisfaction and intention to continue service utilization: analysis of a survey of outpatients at general hospital].

The patient-perceived quality of hospital ambulatory service and its relationship to patient satisfaction and intention to continue utilization of the service were assessed using a questionnaire which was mailed to 1,695 outpatients of a general hospital in Tokyo (response rate, 77.2%). Patient satisfaction and satisfaction and intention of continuing service utilization were each assessed and both for physicians and for the hospital. The quality of hospital outpatient service was evaluated for 36 items, and 9 patient evaluation scales were extracted by factor analysis: i.e., "treatment results", "physician competence and explanation", "physician warmth and commitment", "reputation of hospital and physician", "services by nurses and non-clerical staff", "services by clerical staff", "medical costs and barriers", "hospital environment" and "accessibility to medical care". These scales, with the exception of "accessibility of medical care", had high internal consistency. Accessibility was then decomposed into 4 independent scales-"waiting time", "outpatient clinic hours", "availability of services when needed" and "transportation convenience". The effects of a total of 23 variables, consisting of 12 patient evaluation scales, sex, age, education, income, clinical departments (4 dummy variables), "frequency of service utilization", "perceived severity of disease" and perceived necessity for medical care intervention" on patient satisfaction and patient intention to continue utilization of services were assessed by multiple regression analysis (forced entry method). The results indicated that patient assessment of "treatment results", "physician competence and explanation", "physician warmth and commitment" and "reputation of hospital and physician are important determinants of patients satisfaction and intention to continue using hospital outpatient service.

Health Services↗
PubMed1982

Medicare program; limitation of reasonable charges for services in hospital outpatient settings--HCFA. Final rule with comment period.

These Regulations limit reasonable charge reimbursement for certain physicians' services furnished in hospital outpatient settings. This will be accomplished by refining the application of Medicare reasonable charge screens to reflect more accurately the reasonable charges for physicians' professional medical services in hospital outpatient settings. The regulations are needed to implement recent legislation that is designed to prevent duplicate payment for overhead expenses associated with the delivery of those services.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2002

Satisfaction on outpatient services in hospitals of the Amhara Region.

A cross sectional survey was conducted to assess patients' satisfaction on outpatient services in the hospitals of the Amara Region. A total of 898 patients from nine hospitals were interviewed on exit. The majority (95.9%) had come due to illness, and of which, 53.2% had illnesses that lasted for more than 30 days. Among those who were sick, 47.5% were non-paying (free) patients. Long waiting hours during registration, visiting of doctors after registration, laboratory procedures, and revisiting of the doctors for evaluation with laboratory results and obtaining drugs from pharmacies were associated with dissatisfaction. When logistic regression was applied, waiting time for registration, physician consultation/examination, obtaining the prescribed drugs from the pharmacies, and overall time taken to receive prescriptions were associated with dissatisfaction. Among the sociodemographic factors, age was associated with dissatisfaction. More than one-third of the patients did not get the medications prescribed in the hospital pharmacies. Failure to find the prescribed drugs was associated with dissatisfaction. Unnecessary patient delays should be reduced to the minimum by assessing hospitals' processes. Ensuring drug supply with facilitated administrative processes is recommended.

Adolescent↗
PubMed2003

Drivers of expenditure growth in outpatient care services.

OBJECTIVE: To identify and analyze drivers of costs for healthcare services delivered in outpatient settings. STUDY DESIGN: We estimated 2 regression models of state-level annual outpatient expenditures. The first model uses data on operating costs for hospital outpatient services from hospital cost reports. The second model uses outpatient claims data from a large, national, group health insurer, and covers all varieties of outpatient providers for a specific insured population. RESULTS: Several different cost drivers affected the growth of outpatient costs in the late 1990s. Foremost among the drivers is the change associated with demographics and general economic conditions, and economy-wide inflation, which together accounted for 60% of the growth in outpatient costs. Characteristics directly related to the healthcare sector had a smaller, but still significant role in cost growth. The supply of physicians and specialists accounted for 10% of cost growth, whereas supply and structure of outpatient facilities were responsible for an additional 5% of outpatient cost increase. The health status of the population was associated with 8% of expenditure growth; technology and treatment practices accounted for 7% of growth; and provider operating costs, such as wage levels, were linked to 9% of the growth. CONCLUSIONS: Some level of growth in outpatient care spending may be cost effective, because outpatient services can substitute for more expensive care in other settings. Strategies for limiting growth in the costs of outpatient care will be more effective if focused on enhancing cooperation between payers, providers, and other stakeholders in assuring an appropriate and cost-effective supply of outpatient care resources.

Ambulatory Care↗
PubMedDate not supplied

Episodes of allied health outpatient care: an investigation of service delivery in acute public hospital settings.

This paper describes 'episodes of allied health outpatient care' by linking related clinical allied health outpatient contacts. Episodes were tracked on 10095 patients in 46 public hospital outpatient services in eight hospitals over a 10-month period during 1996, as part of a Commonwealth Ambulatory Care Reform project. Fifty-one per cent of patients completed at least one 'episode of allied health outpatient care' during the period of the study. An episode theoretically comprised all those occasions of service provided to the one patient for the one condition in the one allied health outpatient service, using the one referral. There were difficulties in flagging the beginning and end of episodes, as services used specific ways of defining and recording episode characteristics. Describing allied health outpatient service usage by episode has implications for developing funding models that are appropriate to the core business of allied health services.

Ancillary Services, Hospital↗
PubMed2005

Continuity of care in psychiatric post-ward outpatient services--conceptions of patients and personnel concerning factors contributing to the continuity of care.

A structural change of the psychiatric services was started in Finland in the 1980s. Its primary objective was to shift the main emphasis from hospital to outpatient services. Hence, the number of psychiatric beds has declined to a third of the maximum rate, inpatient periods have shortened and the number of outpatient appointments has increased significantly. International research shows that when the emphasis of psychiatric services shifts to outpatient services and hospitalization becomes short-term, diverse individual alternatives are needed to support patients' coping. Several Finnish psychiatric hospitals initiated in the 1990s outpatient services provided at inpatient wards, which means, that after the period of hospitalization, further care is provided to the patient at the same ward where s/he was hospitalized. The purpose of this study was to describe and analyse the conceptions of patients, ward personnel, outpatient services personnel and administrative personnel in psychiatric units concerning the factors improving the continuity of care. A phenomenographic approach was used and the objective was to find the different empirical variations of the conceptions, through which people experience, comprehend and become conscious of the phenomena in the surrounding world. The data were gathered by interviewing post-ward outpatients (n=5), personnel at psychiatric wards and in outpatient services (n=18) and administrative personnel in psychiatric units (n=5). As a result of the analysis seven categories of the factors improving the continuity of care were formed: (1) adherence to a good cooperative relationship; (2) adherence to the care environment; (3) flexibility in tailoring care; (4) active maintenance of contacts in care; (5) constant possibility to contact the ward; (6) up-to-date patient data; and (7) active cooperation between outpatient services and other collaborators.

Attitude of Health Personnel↗