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At least 127 records · Page 7Linked to original sources
PubMed2002

Financial effect of a hospital outpatient senior clinic on an academic medical center.

OBJECTIVES: To estimate the billed charges generated for the university hospital (UH) by patients seen in a UH outpatient senior clinic over a 6-month period. To estimate the average billed charges per geriatric patient generated for the UH over the same 6-month period. DESIGN: Retrospective analysis. SETTING: Hospital-based outpatient senior clinic at a university medical center. PARTICIPANTS: Outpatients aged 65 and older. MEASUREMENTS: The total inpatient, outpatient, and professional fee charges generated for the UH by the senior health center (SHC) patients were estimated for a 6-month period, with the use of billing data from the professional and hospital billing systems. To estimate the multiplier effect and average charges per SHC patient per year, our analysis focused on professional charges generated directly in the SHC and professional fees and hospital charges generated by secondary referral (inpatient and outpatient). RESULTS: One thousand nine hundred ninety-eight patients were seen in the SHC during the 6-month period. For every $1 billed in professional charges in the SHC, $17 was billed elsewhere in the hospital system. Geriatric medicine professional charges generated by the 1,998 SHC patients over the 6-month period totaled $546,691. The 6-month charges by the rest of the hospital system for the same 1,998 patients included hospital inpatient charges of $4,684,195 for all departments; hospital outpatient charges (ancillary plus technical, including facility fees for the SHC) of $3,027,212; and professional fees of $1,606,287 for other departments, thereby producing a multiplier factor of 17. The average overall charges per geriatric patient per 6 months totaled $4,937, which included hospital inpatient, hospital outpatient, and professional fees. The UH generated an average of $3,860 in hospital charges per SHC patient per 6 months. The average hospital charges generated per established SHC patient per 6 months were $2,936. The average hospital charges for a new SHC patient were $7,187 per 6 months. The average professional charges were $1,078 per patient per 6 months. CONCLUSIONS: This study provides a reasonable estimate of the substantial multiplier, or "flow-through," effect of a senior clinic on its parent medical center. Although senior clinics may be a cost center when viewed in isolation, these clinics are actually revenue generators when viewed from the perspective of the entire health system.

Aged↗
PubMed2004

Antiretroviral therapy in HIV infection: are neurologically active drugs important?

BACKGROUND: The effect on neuropsychological function of antiretroviral drugs that are able to penetrate into the brain in effective concentration (neuroactive drugs) remains unclear. OBJECTIVE: To investigate whether highly active antiretroviral therapy (HAART) containing neuroactive drugs is associated with better neuropsychological performance in patients with human immunodeficiency virus disease. DESIGN: Cross-sectional survey. SETTING: Tertiary referral hospital outpatient clinics. PATIENTS: The study population consisted of 97 individuals positive for human immunodeficiency virus (stage C3, 1993 Centers for Disease Control and Prevention classification) whose condition had been stable on their current HAART regimen for a mean +/- SD of 18.5 +/- 16.5 months and who were aged 48.14 +/- 9.38 years. The patient groups were analyzed according to whether their regimen contained 3 or more neuroactive drugs (neuroHAART group; n = 41) or not (HAART group; n = 56). Thirty seronegative men matched for age and education were recruited as controls. MAIN OUTCOME MEASURE: Neuropsychological performance on 7 cognitive domains. RESULTS: The neuroHAART and HAART groups did not differ from one another on neuropsychological performance, but both patient groups were impaired compared with controls. Impaired patients in each treatment group were compared, and the neuroHAART group showed significantly better memory performance, unrelated to plasma viral load, than the HAART group. CONCLUSION: No direct benefit of neuroactive HAART therapy was found in patients with advanced human immunodeficiency virus infection. However, in neuropsychologically impaired patients, there was a benefit in memory function. This suggests that a threshold of neuropsychological impairment is required for the benefit of neuroactive HAART.

Adult↗
PubMed2005

Relationship between lung function and asthma symptoms in patients with difficult to control asthma.

Several studies have demonstrated a poor relationship between measures of asthma control and lung function in patients with asthma. We sought to examine this relationship in a cohort of difficult to control asthmatics attending a hospital outpatient clinic. FEV1 % and asthma control scores (ACSs) were measured at the first clinic visit and at a follow-up visit. A total of 59 patients took part in the study. At the initial visit, FEV1 % correlated with limitation of activity (p = 0.002), shortness of breath (p = 0.02), wheezing (p = 0.029), and ACS (p = 0.014). However, at follow-up, there was no correlation between FEV1 % and any measured index of asthma control. When patients with severe fixed airflow obstruction were excluded from the analysis (n = 16), FEV1 % at follow-up became significantly correlated with night waking (p = 0.02), wheezing (p = 0.05), and ACS (p = 0.036). The improvement in asthma control score at follow-up was significantly and strongly associated (r = 0.51 for total asthma control, p < 0.001) with the improvement in lung function in patients without severe fixed airflow obstruction. Lung function was not associated with any measure of asthma control in patients with severe fixed airflow obstruction. FEV1 % correlates well with asthma symptoms in difficult asthma patients with poor control but not when control improves. This loss of relationship is due to subjects with severe fixed airflow obstruction where good subjective control does not exclude the presence of significant obstruction. How severe fixed airflow obstruction should be prevented, delayed, or managed in asthma requires further research.

Adult↗
PubMed2001

Specialists as consultants to GPs. Private sector services as an alternative way of organising consultant services in health care.

OBJECTIVE: To assess the effect on referral rate when GPs are given a better opportunity to send their patients to specialists for consultation. DESIGN: Intervention study with a control group. SETTING AND SUBJECTS: A 34-month experiment in the City of Turku. The experimental group consisted of 10 GPs working in municipal health centres with a list system and serving 23000 residents. As a control group, there were four GPs without a list system serving 10800 residents. OUTCOME MEASURES: GP visits and their referrals to specialists. RESULTS: The number of patient visits was higher among GPs in the experimental group than among those in the control group. During the experiment, the referral rate of GPs in the experimental group increased from 5.7% to 6.8%, but there was no change among the control GPs. Of all referrals to specialists, the share to the private sector increased from 5% to 35%, while at the same time the share to the hospital outpatient clinic decreased. CONCLUSIONS: An enhanced possibility to consult private specialists increases the number of referrals, but there are no consequent changes in the relative shares of the consulted specialties.

Cooperative Behavior↗
PubMed1989

Quantifying an ambulatory care patient classification instrument.

The author describes the process used to develop a patient classification system in a large multi-specialty ambulatory care facility. The process involved identifying critical indicators for each specialty area, validating the instruments, and calculating the workload. The approach to sampling and the problems encountered for relatively short visits are discussed.

Ambulatory Care↗
PubMed1984

Occurrence of bacteremia in febrile children seen in a hospital outpatient department and private practice.

Blood cultures were obtained during a one-year period from 147 febrile children seen in the hospital outpatient clinic (group 1), and 42 seen in a private practice office (group 2). Although the two clinics were located in the same geographic area, they served different socioeconomic groups. Bacteremia was detected in 12 (8.2%) of the children in group 1; the organisms recovered were Streptococcus pneumoniae in nine and Haemophilus influenzae in three. Bacteremia was observed in two (4.8%) of the children seen in group 2, and both cases were due to S pneumoniae. The difference in prevalence rates for bacteremia between groups was not significant by chi-square testing (P = .46). The age of all the 13 patients with bacteremia was less than 24 months, their temperature was above 104 F (40 C), their polymorphonuclear leukocyte count was above 15,000/cu mm, and a localized site of infection was present in ten of them. These data suggest that the presence of bacteremia in febrile children depends more on the patients' clinical and laboratory findings than on the medical facility in which they are seen.

Child, Preschool↗