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Biomedical subjects

R G Frank

Publications and source records attributed to R G Frank.

At least 109 records · Page 6Linked to original sources
PubMed1990

Detecting and treating retinopathy in patients with type I diabetes mellitus. A health policy model.

Diabetic retinopathy is the major cause of new cases of blindness among working-age Americans. The authors analyzed the medical and economic implications of alternative screening strategies for detecting retinopathy in a diabetic population. The approaches compared included dilated fundus examination at 6-, 12-, and 24-month intervals with and without fundus photography. Potential savings from screening and treatment are based on amounts paid by the federal government for blindness-related disability. Screening for and treating retinopathy in patients with type I diabetes mellitus was cost-effective using all screening strategies. Between 71,474 and 85,315 person years of sight and 76,886 and 94,705 person years of reading vision can be saved for each annual cohort of patients with type I diabetes mellitus when proper laser photocoagulation is administered. This results in a cost savings of $62.1 to $108.6 million. Annual examination of all diabetic patients and semi-annual examination of those with retinopathy was more effective than annual examination with fundus photography. This screening strategy is consistent with the Preferred Practice Pattern for Diabetic Retinopathy of the American Academy of Ophthalmology.

Adolescent↗
PubMed1990

Rehabilitation. Psychology's greatest opportunity?

Rehabilitation is one of the fastest growing areas in the health industry. Supported by several key pieces of legislation, psychologists have established themselves as integral health care providers in rehabilitation. Although psychologists have benefited from legislated membership in rehabilitation, most individual psychologists and the psychological associations have failed to recognize the importance of public policy for the practice of psychology. Escalating health care costs have resulted in major revisions in the manner in which health insurers reimburse treatment. Medicare, the major federal health insurance provider, increasingly has been viewed as a model for the provision of all health care. The historic exclusion of psychologists from Medicare has limited the scope of psychologists' practice and the growth of professional psychology. The recent inclusion of psychologists in Medicare improves but does not solve practice and policy issues confronting psychology. Knowledge of national health policy formulation and greater participation by psychologists in health policy is necessary to secure the scope of professional practice most psychologists expect.

Persons with Disabilities↗
PubMed1990

Design for the national evaluation of the Robert Wood Johnson Foundation Program on Chronic Mental Illness.

The Robert Wood Johnson Foundation chose the University of Maryland Mental Health Policy Studies Program to conduct an independent national evaluation of its Program on Chronic Mental Illness, a large-scale demonstration in which nine cities across the country are participating. The national evaluation aims at describing the implementation of the program and assessing its impact on clients. The evaluation effort comprises five groups of interrelated studies: a site-level study, a community care study, housing studies, financing studies, and disability and vocational rehabilitation studies. Taken together, the components of the evaluation should provide evidence that will help create new structures and processes in large cities for delivering care to persons with chronic mental illness.

Chronic Disease↗
PubMed1990

Short-term memory processes following closed head injury.

Survivors of severe closed head injury (CHI) were compared with neurologically normal matched controls on measures of short-term memory processes. The results indicate that patients with CHI took longer to scan their short-term memory than controls, and this increased disproportionately as the memory load increased. The number of errors made in scanning short-term memory increased for patients with CHI, suggesting inefficient as well as slow scanning. These differences were present despite equivalent memory span between groups. The results of this study have implications for day to day memory processes that require manipulation of information in short-term memory.

Journal Article↗
PubMed1990

Effect of the structure of hospital payment on length of stay.

In response to rapidly rising costs, payers for health care services have made a number of changes in the way they reimburse hospitals for care. In this article we study the effect of different payment methods on the length of stay of Medicaid patients. We examine supply response by type of patient (medical, surgical, and psychiatric) and hospital ownership. We find that per case payment systems and negotiated contracts lead to significant decreases in the length of stay for all groups. Prospective per diem with limits in most cases leads to decreases in the length of stay. In general, we find that the supply response is stronger for psychiatric patients than for medical and surgical patients, and that publicly owned hospitals are more responsive to payment system incentives than are nonpublic hospitals.

Cost Control↗
PubMed1990

Psychological screening in rheumatoid arthritis.

Our objective was to examine the utility of the Symptom Checklist-90-R (SCL-90-R) as a psychological screening instrument for patients with rheumatoid arthritis (RA). Subjects were 81 male and 3 female patients with classic or definite RA who were categorized into 3 anatomic stage groups based on roentgenograms. Erythrocyte sedimentation rates, joint counts, and the SCL-90-R were obtained on all subjects. In addition, rheumatologists were surveyed, and items were analyzed to identify potential disease related items on the SCL-90-R. Both the survey and the item analyses supported the utility of the SCL-90-R as a psychological screening instrument in a population with RA.

Aged↗
PubMed1989

Pain control and rational thinking. Implications for rheumatoid arthritis.

In this study, we examined the factor structure of the Coping Strategies Questionnaire and studied the relevance of the coping process to health status in rheumatoid arthritis patients. The 2 factors of the questionnaire that were analyzed were Coping Attempts and Pain Control and Rational Thinking. The Pain Control and Rational Thinking factor was related to pain and psychological status, even after demographic variables and disease severity were statistically controlled. In addition, increases in Pain Control and Rational Thinking scores were related to improvements in pain, psychological status, and health status. Implications for the psychological care of rheumatoid arthritis patients are discussed.

Adaptation, Psychological↗
PubMed1989

Human penile ossification: a case report and review of the literature.

Human penile ossification is a rare event. Only a limited number of cases have appeared in the literature. Several reported cases have been related to local trauma and plastic induration of the penis. We report an additional case with a comprehensive review of case reports in the literature.

Humans↗
PubMed1989

The impact of prospectively set hospital budgets on psychiatric admissions.

This article examines the impact of prospectively set hospital budgets on rates of admission of psychiatric patients in New York state, U.S.A. The analysis takes advantage of a natural experiment which took place in the early 1980s, whereby a geographic region adopted a prospective hospital budget reimbursement scheme that differed from the prospective per diem reimbursement scheme used in the rest of the state. The results indicate a strong decrease in psychiatric admissions attributable to the experimental payment method.

Admitting Department, Hospital↗
PubMed1989

Spinal cord injury and health locus of control beliefs.

Individual beliefs about control over their health were assessed in 53 patients with spinal cord injury. Patients who believed they exercised control over their health were less depressed than patients who were fatalistic. A significant number of patients were found to be higher in their internal attributions of health control (N = 31) than those who believed in chance (N = 5) and those who believed medical personnel were in control of their health (N = 11). The results are integrated with a past study of depression following spinal cord injury and locus of control beliefs.

Adolescent↗
PubMed1989

Regulatory policy and information deficiencies in the market for mental health services.

This paper addresses issues related to the regulation of the delivery of mental health services. The focus is primarily on regulations that are aimed at dealing with the consequences of imperfect information in the marketplace. The paper reviews and assesses what is known about the impact of regulations on efficiency and equity. One conclusion is that we know a fair amount about impacts of regulation on prices for mental health service and very little about effects on quality of care. A research agenda is proposed based on the knowledge available in 1988.

Attitude to Health↗
PubMed1989

A comparison of hospital responses to reimbursement policies for Medicaid psychiatric patients.

Hospital expenditures continue to increase at rates that are higher than that of GNP growth. Policymakers are experimenting with a number of reimbursement methods in an attempt to curtail the growth in hospital costs. This article empirically assesses the impact of various hospital reimbursement methods on the use of hospital services. We specified and estimated a model of hospital duration for Medicaid psychiatric patients. A new semiparametric approach to estimation was implemented for a large national sample of hospital discharges. The empirical findings show significant reductions in hospital duration are associated with per case prospective payment as compared with cost-based reimbursement.

Data Collection↗
PubMed1989

The effect of Medicaid policy on mental health and poverty.

This paper examines the interrelationships between mental distress, poverty, and Medicaid eligibility policy. This is accomplished by estimating an econometric model of mental health and income. We use data from a community survey to estimate the model. Simulations of the impacts of changes in Medicaid eligibility policy are performed using the model estimates. A central finding is that while there are gains in both mental health status and earnings from changes in Medicaid, the effects on poverty are small because of the design of transfer programs. Suggestions for further research are offered.

Educational Status↗
PubMed1989

Determining provider choice for the treatment of mental disorder: the role of health and mental health status.

This article specifies and estimates a model of provider choice for mental health services. Three types of providers are identified: specialty mental health providers, general medical providers, and informal providers. Specific attention is paid to the role of health and mental health status in determining provider choice. The model is estimated using a multinomial logit approach applied to a sample of 2,800 respondents to the Baltimore Epidemiological Catchment Area Survey. The results are largely consistent with the previous work of Wells et al. (1982), suggesting that health and mental health status play an important role in the decision to seek care but have little effect on the type of provider chosen. The results also reveal that 22 percent of individuals obtaining mental health care did so through the informal care sector. One exemplary benefit design simulation is performed using the estimation results.

Baltimore↗