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PubMed1988

[The home visit--a study of ambulatory management of psychiatric patients within the scope of 2 mobile outpatient services].

Domiciliary visiting and follow-up care of mentally ill patients is one of the foci of treatment-and-care activities of a mobile outpatient care unit working in social psychiatry. Its self-declared aim is to either avoid or to cut down inpatient treatment or reference to a psychiatric hospital or asylum, and thus to enable the patient to lead a life of greater freedom and fewer restrictions. 217 home visits by members of two psychiatric mobile outpatient care units were evaluated and analysed via a descriptive and differentiated questionnaire study. The analysis revealed that patients themselves had requested a visit in only 12.4% of the cases. This seems to be a characteristic feature of psychiatric care. Another striking factor is the mediation by a "third person", for in almost 40% of all the cases the initiative came from relatives, neighbours, the family doctor, the police, the welfare office, the landlord and others, showing how closely follow-up care is interlinked with the patient's social environment. The style of working of the psychiatric care unit is reflected by the varied participation of representatives of different professions in the home visiting service. It is also remarkable that in 31 patients (i.e. 18% of the home visits) the home visit established the first contact between therapist and patient. Whenever such an initial contact was accomplished, the home visit always had a triadic structure. It is a direct consequence of our study that the members of a mobile psychiatric care service should boldly tackle the problems of basic concepts regarding the position and status of the individual within the system of psychiatric and welfare care.

Ambulatory Care↗
PubMed2000

One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims.

OBJECTIVE: This study examined rates and cost of inpatient and outpatient treatment among 1,932 patients with an eating disorder. METHOD: One-year (1995) data were available through MarketScan, a national insurance database containing claims for 1,902,041 male patients and 2,005,760 female patients. RESULTS: Female patients (n = 1,756, 0.14% of all females) were significantly more likely to have been treated for an eating disorder than male patients (n = 176, 0.016% of all males), and females received more days of treatment than males. Outpatient treatment was the norm, regardless of gender or type of eating disorder. Average number of days (inpatient or outpatient) was less than the minimum recommended by standards of care. Age-adjusted costs for the treatment of anorexia nervosa and bulimia nervosa were comparable to the cost of treatment for schizophrenia. DISCUSSION: The utilization data are discussed in terms of barriers to care and treatment guidelines for eating disorders.

Adolescent↗
PubMed2000

Medicare program; prospective payment system for hospital outpatient services. Health Care Financing Administration (HCFA), HHS. Interim final rule with comment period.

This interim final rule with comment period provides for the annual update to the Medicare hospital outpatient prospective payment system conversion factor that is used to calculate the payment amount for each payment group, effective January 1, 2001. It also updates the wage index values and incorporates the year 2001 changes in the procedure codes that are used to make payments under this system. In this rule, we are also responding to public comments received on those portions of the April 7, 2000 final rule with comment period (which established the hospital outpatient prospective payment system) that implemented related provisions of the Balanced Budget Refinement Act (BBRA) of 1999. In addition, we are responding to public comments on the August 3, 2000 interim final rule with comment period that modified the April 7, 2000 final rule with comment period by revising the criteria used to define new or innovative medical devices, drugs, and biologicals eligible for transitional pass-through payments and correcting the criteria for grandfathering provider-based Federally Qualified Health Centers (FQHC) into the prospective payment system.

Ambulatory Care↗