Quality of care in profit vs not-for-profit dialysis centers.
Explore the source record for details and available documents.
Hemodialysis Units, Hospital↗
Biomedical subjects
John S Lyons
Publications and source records attributed to John S Lyons.
Factors related to psychiatric hospital readmission among children and adolescents in state custody.
OBJECTIVE: This study examined factors related to psychiatric hospital readmission among children and adolescents who were wards of the Illinois Department of Children and Family Services. METHODS: The authors analyzed service reports and clinical ratings on the Childhood Severity of Psychiatric Illness (CSPI) for 500 randomly selected children and adolescents who underwent psychiatric hospitalization. Children who were readmitted to the hospital within three months of discharge from the index hospitalization were compared with those who were not readmitted in terms of preadmission factors, clinical characteristics at the index hospitalization, services in the hospital, and posthospital services. RESULTS: The children who were readmitted were rated as more learning disabled or developmentally delayed and had received fewer posthospital service hours than the children who were not readmitted. The highest rates of readmission were found among children who lived in congregate care settings before the index hospitalization and those who lived in a rural region. CONCLUSIONS: The findings of this study highlight the significance of enabling factors, notably living arrangement, geographic region, and posthospital services, for children and adolescents in the child welfare system. Prevention of readmission among these children must focus on community-based services.
Adolescent↗
Panic attacks in schizophrenia.
OBJECTIVE: To determine the association between panic attacks and comorbid mental disorders, psychiatric symptomotology, service utilization, and suicidality among individuals with schizophrenia in the community. METHOD: Data were drawn from the Epidemiologic Catchment Area (ECA) Study (n=20, 291). Differences in comorbid mental disorders, symptomotology, service use, and suicidality were determined between individuals with schizophrenia, with and without panic attacks. RESULTS: Panic attacks (lifetime) were common among almost half (45%) of those with schizophrenia. Individuals with schizophrenia and panic attacks had significantly elevated rates of co-occurring mental disorders, psychotic symptoms, suicidality, and mental health service utilization compared with individuals with schizophrenia who did not suffer from panic attacks. CONCLUSIONS: Panic attacks are common among individuals with schizophrenia in the community and are associated with higher rates of other co-occurring mental disorders, service utilization and suicidality. These results suggest that concurrent treatment for both panic and schizophrenia may be indicated for optimal outcomes. Future research is needed to determine the direct and indirect cost benefit in providing mental health treatment for panic among individuals with schizophrenia in the community.
Adult↗
Use of measurement audit in outcomes management.
With the growing emphasis on accountability in mental health services, outcomes management strategies are gaining popularity. However, for these techniques to be credible, it is necessary to ensure the reliability of clinical data. In other words, outcomes measures must accurately reflect the actual status of service recipients. This article presents the use of the measurement audit as one means of monitoring and improving the reliability of outcomes measurements. The methods and findings from an audit of crisis assessment workers for children in state custody are presented. Clinical assessments completed at the time of service were compared with assessments using the same measure completed via retrospective file review. Findings suggest generally good reliability, 0.72 overall, with some variation by provider and type of information.
Child↗
Mental health service utilization in the United States. The role of personality factors.
BACKGROUND: The aim of this study was to determine the relationship between personality factors and the use of mental health services (past 12 months) among adults in the community. METHOD: Data were drawn from the Midlife Development in the United States Survey (MIDUS), a representative sample of 3,032 adults aged 25-74 in the United States population. Analyses of variance and logistic regression analyses were used to determine the relationship between personality factors and mental health service utilization, in the presence and absence of mental disorders, during the past 12 months. RESULTS: Neuroticism [OR = 1.5 (1.2, 1.9)] was associated with significantly increased likelihood of mental health service utilization among adults in the community. Conscientiousness [OR = 0.7 (0.5, 0.9)] and extraversion [OR = 0.7 (0.5, 0.98)], in contrast, were associated with decreased likelihood of use of mental health services. Among adults with mental disorders, conscientiousness [OR = 0.5 (0.3, 0.8)] was associated with decreased odds of mental health service utilization. Neuroticism [OR = 1.8 (1.3, 2.4)] was associated with increased likelihood of service use among those who did not meet criteria for common mental disorders. CONCLUSIONS: These findings are the first to document a significant association between personality factors and the use of mental health services among adults in the general population. Our results highlight new ways in which personality may influence mental health in the community. This information may be useful in identifying those with unmet need for mental health treatment and developing more effective interventions for those at risk for common mental disorders. Replication of these findings is needed.
Adult↗
The effects of copayments on substance abuse treatment expenditures and treatment reoccurrence.
OBJECTIVE: Employers can influence treatment decisions by adjusting characteristics of the structure of the benefits they offer, such as copayments. The authors estimated the relationship between copayment levels for substance abuse treatment and both the insurers' expenditures for treatment and the reoccurrence of treatment. METHODS: Retrospective data from a Midwestern behavioral health insurer were used to identify persons with a diagnosis of a substance use disorder. The claims data were used to construct episodes of treatment. Using the variation in copayment levels across 211 different employer groups, the authors used multiple regression models to estimate the effect of copayment levels on treatment expenditures and the likelihood of a treatment reoccurrence. RESULTS: Copayment levels had a significant effect on the reoccurrence of substance abuse treatment. Each 10 percent increase in copayment was associated with a 1 percent increase in the probability of reoccurrence. Copayment levels had a significant effect on current-episode treatment expenditures. Each 10 percent increase in copayment was associated with an 8.7 percent decrease in total per-episode expenditures. From the plan's perspective, a $1 increase in copayment for outpatient substance abuse treatment reduced per-episode spending by $110; however, roughly $13 is lost from that saving because of the increased likelihood of treatment reoccurrence. CONCLUSIONS: The longer a person is retained in substance abuse treatment, the greater the likelihood of recovery. Copayments may represent a barrier to retention in treatment. Higher copayments for substance abuse treatment make treatment reoccurrence more likely.
Adult↗