PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “OUTPATIENT SERVICE”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 973 records · Page 54Linked to original sources
PubMed1992

[Surgical indications for partial inpatient and ambulatory surgery of the lower extremities].

Outpatient (ambulatory) surgery has become widely accepted in free-standing outpatient surgery centres and in hospitals covering the field of hand surgery as well as, increasingly, the field of lower-extremity surgery. Three factors are decisive for secure ambulatory surgery: adequate material and personal resources guaranteeing a round-the-clock medical service, outpatient anesthesia which focuses mainly on the perioperative care of outpatient surgery, and a well-informed patient. Under these prerogatives the majority of surgical procedures of the lower extremities are performed on an outpatient basis without any undue risk. This includes also the diagnostic and operative arthroscopy of different joints.

Adult↗
PubMed1997

Costs to Medicaid of advancing immunosuppression in an urban HIV-infected patient population in Maryland.

Human immunodeficiency virus (HIV) infection is increasingly an urban disease in the United States, and Medicaid is the principal payer of the health care costs of patients with HIV. We wished to determine the costs to Medicaid of patients in Maryland infected with HIV as immunosuppression progresses, and to determine how costs varied by demographic characteristics of the patient. We analyzed combined economic and clinical data in patients from the Johns Hopkins HIV Service, the provider of primary and specialty care for a majority of HIV-infected patients in the Baltimore metropolitan region. All patients were enrolled in Medicaid and received care longitudinally in Maryland from July 1992 to June 1995. Monthly Medicaid payments were calculated for all inpatient and outpatient services by sex, race, age, use of injecting drugs, CD4+ count (>500, 201-500, 51-200, < or =50 cells/mm3), several opportunistic diseases, and death. Lifetime costs were also calculated by use of a Markov simulation. During 13,174 person-months of follow-up in 606 patients, a total of $18,223,700 in Medicaid payments was made. Mean monthly payments ranged from $2,436 (SE $171) for patients with CD4+ counts < or =50 cells/mm3 to $1,015 (SE $177) for patients with CD4+ counts >500 cells/mm3. Mean monthly inpatient costs ranged from $1,355 (SE $131) for CD4+ counts < or =50 cells/mm3 and $617 (SE $164) for CD4- counts >500 cells/mm3. For those with CD4+ counts < or =50 cells/mm3, outpatient pharmacy costs averaged $515 (SE $57) monthly, second only to inpatient costs. In bivariate analysis, costs were significantly higher (p = .013) in men (mean $1696; SE $126) than in women (mean $1,208; SE $101), though the difference was not significant with multivariate adjustment. Cytomegalovirus retinitis was the most costly opportunistic disease, with mean monthly costs of $7,825 (SE $1,141) within the 6 mo after diagnosis. Within 6 mo of death, mean monthly costs are $4,600 (SE $424). Lifetime costs for treating an HIV-infected patient who presents with a CD4+ count >500 cells/mm3 are $133,500 over 8.3 years of life. We concluded that in the clinic where the analysis was done, average costs to Medicaid of treating patients increase more than two-fold as the CD4+ count declines from >500 cells/mm3 to < or =50 cells/mm3. Interventions that decrease hospitalization, opportunistic disease, and the costs of terminal care may be most likely to decrease overall costs. Demographic patient characteristics do not affect costs significantly when access to care is comparable.

AIDS-Related Opportunistic Infections↗
PubMed2003

Using cost-effectiveness analysis to compare Hospital at Home and in-patient interventions. Part 2.

An economic analysis was conducted as an integral part of a comparison of the effectiveness and suitability of Hospital at Home (HaH) and in-patient interventions. The sample comprised 109 adult primary total joint replacement patients and 21 of their co-resident informal carers. Part 2 is principally a methodology paper and describes how nurses may use a variety of methods to compare cost between treatment modalities. A Cost-Effectiveness Analysis framework uses the data from Paper 1 to calculate the economic feasibility of HaH compared with traditional in-patient interventions as a worked example of how the principles of economic analysis can be used within health care research. The basic information for calculating cost of both interventions was obtained by multiplying the mean length of total treatment days by the cost per treatment day. However calculating and comparing cost for in-patient and HaH modalities was multifaceted and included costs incurred by patients and families as well as any shift in cost from tertiary to community and outpatient services. Application of the cost-effectiveness analysis framework demonstrated that not only was HaH more effective than in-patient care in several aspects, but also it was less costly because of a mean reduction in length of stay of 0.9 days per patient and a significant reduction in cost per treatment day because of removal of hospital overhead costs and reduced special duty payments even when offset against additional transport, community and outpatient costs.

Adult↗
PubMed1990

Hospital readmissions, otolaryngology, and the diagnosis related group hospital payment system.

An analysis of otolaryngologic patients requiring readmission was conducted at our institution during a 4-year period to determine the number of readmissions per patient and the time between discharge and hospital readmission. Readmitted otolaryngologic patients were found to have had greater hospital resource utilization, financial risk under diagnosis-related group payment, and mortality, compared with those patients not readmitted to our facility. For patients readmitted to otolaryngologic services (21.2% of total otolaryngologic patients), 20.4% of the readmissions occurred within 30 days of hospital discharge. Of these, 39.3% required one hospital readmission, 16.3% required two readmissions, and 46.4% of the patients called for three or more hospital admissions. Clinical factors were identified that resulted in a greater incidence of otolaryngologic readmission. Otolaryngologic patients readmitted to other clinical services were also studied. This analysis loads to the conclusion that inequities exist within the diagnosis related group hospital payment system vis-à-vis otolaryngologic readmissions. The results of these data also demonstrate leverage points in which we will be able to focus outpatient services for otolaryngologic patients requiring readmission and potentially decrease inpatient hospital expenditures in the days ahead.

Academic Medical Centers↗
PubMed1994

Patient satisfaction and postoperative demands on hospital and community services after day surgery.

This study presents the outcome of a survey of patients satisfaction following day surgery and an assessment of the level of contact between patients and community services within the first 48 h after discharge from a day-surgery unit. A total of 953 patients were provided with a self-completion questionnaire after day surgery; replies were received from 557 (58.4 per cent). Areas investigated regarding overall satisfaction were outpatient services, admission procedure, day-surgery services, preoperative and postoperative information, and postoperative pain relief. The incidence of contact with the hospital or community services in the 48 h after operation was also recorded. Overall satisfaction following day surgery was very high. Only 2.5 per cent of respondents reported that they had needed to contact the hospital within 24 h of discharge. Contact with community services in the 48 h after operation was minimal. Only 4.3 per cent consulted their general practitioner and 1.4 per cent a district nurse. For the small number of patients who did contact the hospital or their general practitioner, the most frequent reason was a problem with pain management.

Adolescent↗
PubMed1992

Case-based reimbursement for psychiatric hospital care.

A fixed-prepayment system (case-based reimbursement) for patients initially requiring hospital-level care was evaluated for one year through an arrangement between a private nonprofit psychiatric hospital and a self-insured company desiring to provide psychiatric services to its employees. This clinical and financial experiment offered a means of containing costs while monitoring quality of care. A two-group, case-control study was undertaken of treatment outcomes at discharge, patient satisfaction with hospital care, and service use and costs during the program's first year. Compared with costs for patients in the control group, costs for those in the program were lower per patient and per admission; cumulative costs for patients requiring rehospitalization were also lower. However, costs for outpatient services for patients in the program were not calculated. Treatment outcomes and patients' satisfaction with hospital care were comparable for the two groups.

Adolescent↗
PubMed1992

Children in foster care in California: an examination of Medicaid reimbursed health services utilization.

The number of children in foster care in California doubled from 27,534 in 1980 to more than 62,419 in 1988, representing approximately 1% of the child population in the state. Past studies have demonstrated that children in foster care have high rates of medical and mental health problems. An examination of all Medi-Cal-paid claims was undertaken to describe the utilization of health services by children in foster care. Although children in foster care represent 4% of Medi-Cal-eligible children younger than 18 years of age, they account for approximately 5% of children using Medi-Cal services and 6.7% of expenditures, representing a 23% greater utilization rate and 41% greater expenditure rate than all children covered by Medi-Cal. Using the entire Medi-Cal population younger than 18 years of age as comparison group, examination of inpatient and outpatient service utilization for specific condition categories showed few differences between children in foster care and the comparison group except for mental health service utilization, where children in foster care were much higher users of services.

Adolescent↗
PubMed2004

Discontinuation of cost sharing in Uganda.

OBJECTIVE: To assess the effects of ending cost sharing on use of outpatient services and how this was perceived by health workers and members of a health unit management committee. METHODS: From 10 districts across Uganda, 78 health facilities were selected. Attendance at these facilities was assessed for eight months before and 12 months after cost sharing ended. The data represented 1 966 522 outpatient visits. Perceptions about the impact of ending cost sharing were obtained from the 73 health workers and 78 members of the health unit management committee who were available. FINDINGS: With the end of cost sharing, the mean monthly number of new visits increased by 17 928 (53.3%), but among children aged <5 years the increase was 3611 (27.3%). Mean monthly reattendances increased by 2838 (81.3%) among children aged <5 years and 1889 (24.3%) among all people. Attendances for immunizations, antenatal clinics, and family planning all increased, despite these services having always been free. Health workers reported a decline in morale, and many health unit management committees no longer met regularly. CONCLUSION: Use of all services increased - even those that had never before been subject to fees. The loss of some autonomy by the health facility and diminished community governance of health facilities may have long term negative effects.

Attitude of Health Personnel↗
PubMedDate not supplied

[Resource provision of public health services in the Volga federal region].

Structural reforms in the public health system makes it necessary to examine the status and trends in the use of resources in both Russia and in some regions. Objects for the study were chosen among the areas most characteristic of the Volga Federal Okrug and socioeconomic and ethnic-confessional diversity of its regions. Reforms in inpatient and outpatient service for the population are analyzed. Both positive results in the optimization of structural reforms in the public health system and some negative trends were found.

Ethnicity↗
PubMed1995

[The advanced training of the therapists in a local medical association without interrupting their performance of service obligations as a variant in the postgraduate raising of qualifications on a permanent basis].

A new approach to continuous medical education of district physicians implies 4-5 annual (100-120 teaching periods) which are delivered to groups of 10 medical professionals for 4 days a week. The education is intended annually for 50 district therapists and other specialists and is especially helpful if outpatient service is organized according to the team principle (obstetrician, pediatrician, therapist). The lectures cover present-day advances in medical practice and research with special emphasis to borderline conditions.

Ambulatory Care↗
PubMed1997

Mental health expenditures for services for people with severe mental illnesses.

OBJECTIVE: To provide comprehensive information on expenditures for mental health and substance abuse services for a large number of people with severe mental illnesses, this study examined use of major types of clinical-medical mental health and psychiatric rehabilitation services over a one-year period. METHODS: Data were obtained for 1,890 clients in ten public county-based nonmetropolitan mental health systems in Wisconsin. Expenditures were for services provided with public funding, including local sources of funding, Medicaid, and Medicare. Data about services and expenditures were obtained from county records and unduplicated Medicaid claims for 12 months in 1989 and 1990. RESULTS: Expenditures per client averaged $10,995 for one year ($13,992 in 1994 dollars), with a maximum of $95,093. Expenditures for community-based outpatient services, including residential care and vocational services, represented 53.5 percent of all expenditures; residential care accounted for 12.4 percent and vocational services for 5.7 percent. Overall, 46.5 percent was spent for institutional care, with inpatient hospital care accounting for 12.6 percent. Approximately 40.6 percent of total expenditures were for services not typically covered under managed care plans. CONCLUSIONS: Expenditures for community-based care accounted for more than half of total expenditures. Expenditure patterns revealed the important role of social and rehabilitation services, a role that must be continued in managed care arrangements if they are to provide adequate services for people with severe mental illnesses.

Adult↗
PubMed1977

Factors in the utilization of mental health centers and state hospitals.

Several studies have found a relationship between the distance that must be traveled to receive a mental health service and the rate of utilization of the service. In the study of admission rates to mental health centers and state hospitals reported here, the author examined the relationship of admission rates to distance and to three other factors: urban-rural differences, the complexity of the community referral network, and the availability of outpatient services. The study showed that rates of admission to the centers tended to be higher as the counties became more urban, but that use of center services was not related to distance. However, a strong relationship was found between distance and rates of admission to the state hospitals.

Geography↗
PubMed2006

Transfusion practices for patients with sickle cell disease at a major academic medical center.

The University of North Carolina at Chapel Hill (UNC) is a tertiarycare, academic university hospital and a major referral center for patients across the state of North Carolina. This 700-bed, Level 1 trauma center transfuses more than 22,000 RBC units to patients annually. Clinical services and areas of the hospital which rely most heavily on transfusion support for their activities are transplantation (bone marrow and solid organ), hematology, critical care (medical and surgical intensive care units), cardiothoracic surgery, pediatrics, the operating room, the emergency department, labor and delivery, dialysis, and outpatient services. UNC is recognized for its expertise in coagulation, transfusion medicine, and hematology, particularly in sickle cell disease (SCD). The sickle cell center at UNC, which began in 1980 and continues today, in conjunction with our neighboring institution,Duke University Medical Center, is designated as part of a National Institutes of Health comprehensive sickle cell center. Several of the physicians are dedicated to the care of pediatric and adult patients with SCD, as well as to research on transfusion management of these patients and recruitment of African American blood donors. This article describes the practices of this institution for transfusion management of patients with SCD, as well as some of its efforts related to this challenging area of transfusion medicine.

Academic Medical Centers↗
PubMed1995

Outcomes of elderly stroke patients. Day hospital versus conventional medical management.

BACKGROUND AND PURPOSE: Much controversy exists over the value of geriatric day hospitals in the rehabilitation of elderly patients, and cerebrovascular accident is a particularly common diagnosis among patients referred to these day hospitals. We carried out a prospective, randomized study to compare the outcomes of elderly stroke patients managed by a geriatric team using a day hospital facility versus conventional medical management. METHODS: One hundred twenty elderly patients with acute stroke were randomized to inpatient care on a stroke ward under the care of either a neurologist or a geriatric team. Those under the care of neurologists were hospitalized until the attending physician felt that the patients had reached full rehabilitation potential. Patients under the care of the geriatric team were discharged home as soon as the team felt they were able to cope and given follow-up rehabilitation at the day hospital. Family or community support was arranged when necessary for both treatment groups. On recruitment, patient demographics, medical history, clinical features related to stroke, and functional ability as measured by the Barthel Index were noted. Subjects were reviewed at 3 and 6 months to assess functional level, hospital and outpatient services received, general well-being, mood, and level of satisfaction. Costs of treatment of the two groups were also compared. RESULTS: Functional improvement (Barthel Index score) was greater in the group managed by the geriatricians with a day hospital facility compared with the conventional group at 3 months (P = .03). There were also fewer outpatient visits among the day hospital patients at 6 months (P = .03). No significant difference was found in costs between the two treatment groups. CONCLUSIONS: Compared with conventional medical management, care in the geriatric day hospital hastened functional recovery and reduced outpatient visits in elderly stroke patients without additional cost.

Activities of Daily Living↗
PubMed1990

Designing services for the elderly.

Even after careful planning and a successful launch, even the best geriatric care program can not always expect smooth sailing, according to industry executives. Allen Mathies, president and chief executive officer at Huntington Memorial Hospital, cited a paradoxical side effect stemming from the success of his hospital's geriatric outreach programs. "On the one hand, by moving patients through a continuum of outpatients services, our program has helped to reduce the extraordinary costs associated with acute care hospitalization," he said. "On the other hand, those patients who are hospitalized tend to be more acutely ill. They use tremendous resources, but at a fixed reimbursement. There is a lack of recognition of our real costs by the payer." Why, then, do Huntington Memorial Hospital, Baptist Medical Center of Oklahoma, Morton F. Plant Hospital, Northwestern Memorial Hospital and other hospitals intend to continue their efforts on behalf of their communities' aging populations? The answer is that, reimbursement problems notwithstanding, benefits can be derived from making a commitment to geriatric care. "We have 19,000 people enrolled in our elder care program," Hupfeld said. "That's a powerful force. They vote. They lobby on our behalf. They support the hospital philanthropically. If you do a good job of reaching the older adults in your community, you'll find they are a powerful marketing force. They can do a lot for your image when it comes to reaching other market segments."

Aged↗
PubMed1989

How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations?

It has been suggested that the use of financial incentives by health maintenance organizations (HMOs) may change physicians' behavior toward individual patients. To test this hypothesis, we used a regression analysis of data from a survey of HMOs to examine the relation between the presence of financial incentives and two measures of the use of resources (the rate of hospitalization and the rate of visits for outpatient services) and one measure of the HMOs' financial viability (the achievement of break-even status). When we controlled for the effect of market-area variables, we found that some forms of compensation were significantly associated with these indicators of decision making by physicians. Among methods of paying physicians, the use of capitation or salaries was associated with a lower rate of hospitalization than the use of fee-for-service payment; physicians in for-profit HMOs and group-model HMOs also used the hospital less often. Placing physicians at financial risk as individuals and imposing penalties for deficits in the HMO's hospital fund beyond the loss of withheld funds were associated with fewer outpatient visits per enrollee, but a higher percentage of HMO patients in a physician's caseload was associated with more frequent visits. HMOs were more likely to break even if they were larger, older, had physicians who treated more HMO patients, and placed physicians at personal financial risk for the cost of outpatient tests; break-even status was also related to the type of HMO. We conclude that the use of some, but not all, financial incentives, as well as the type of HMO, does influence the behavior of physicians toward patients. It remains to be determined how these factors affect the quality of care.

Decision Making↗
PubMed2002

Rising healthcare spending gives pause to Congress and the public.

A recent Centers for Medicare and Medicaid Services (CMS) report announced that the nation's overall rate of growth in healthcare spending rose for the second consecutive year in 2000. The increase occurred in both private and public sectors of the healthcare industry, affecting areas such as prescription drugs, hospitals (including both inpatient and outpatient services), and freestanding nursing homes and home health agencies. CMS's findings may signal the beginning of a new period of healthcare inflation, accompanied by calls from Congress and the public for greater cost controls on the part of providers.

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