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PubMed1994

Patient-centered care through consolidation of outpatient services.

Prior to an innovative consolidation, it could take two hours to complete outpatient testing at the Ephraim McDowell Medical Center in Danville, Kentucky. Outpatients were subjected to time-consuming journeys through the hospital to find different departments. Frequently, they lost their way and entered restricted areas of the hospital. A quality improvement (QI) team was formed to implement a consolidation plan that had been developed by the radiology administrator and approved by upper management. In the end, three outpatient services were integrated into one location, greatly simplifying the process for patients and increasing efficiency for all. The consolidation was accomplished by reconfiguring existing space. It was open for service just two months after the QI team was formed. Outpatient testing can now be completed in 30 to 40 minutes.

Centralized Hospital Services↗
PubMed1991

Civilian Health and Medical Program of the Uniform Services (CHAMPUS); annual fiscal year deductible for outpatient services or supplies--DoD. Final rule.

This amendment incorporates the applicable provisions of recent statutes relevant to the deductible amounts for outpatient care. Public laws 101-510 and 101-511 provide that effective April 1, 1991, the deductible amounts for medical care or services will increase from fifty dollars ($50.00) to one hundred and fifty dollars ($150.00) for an individual and from one hundred dollars ($100.00) to three hundred dollars ($300.00) for a family to include all CHAMPUS beneficiaries except dependents of active duty sponsors in pay grades E-4 or below. However, the Persian Gulf Conflict Supplemental Authorization and Personnel Benefit Act of 1991, Public Law 102-25, stipulates that, in the case of dependents of a member of the Uniformed Services who served or serves on active duty in the Persian Gulf theater of operations in connection with Operation Desert Storm, the provisions of Public Laws 101-510 and 101-511, shall not become effective until October 1, 1991. This latter category is defined in the rule as those dependents whose sponsors, are, or were, entitled to Special pay for Hostile Fire/Imminent Danger authorized by section 310 of title 37, United States Code, for service in the Persian Gulf Area.

Ambulatory Care↗
PubMed2006

Worker productivity and outpatient service use after the September 11th attacks: results from the New York City terrorism outcome study.

BACKGROUND: Research has shown that the terrorist attacks in New York City (NYC) on September 11, 2001 had an impact on the psychological status of area residents. Since a major goal of many terrorist attacks is to also adversely affect local socioeconomic activities, the long-term impact of exposure to terrorist attacks on productivity and outpatient service utilization among workers in NYC is assessed. METHODS: The impact of the World Trade Center disaster (WTCD) among 1,167 workers in NYC is examined using a prospective cohort design. The study included measures of WTCD exposures, stressful life events, other traumatic events, post-traumatic stress disorder (PTSD), and depression, assessed at 1 year and 2 years post-disaster. RESULTS: Bivariate analyses suggest that exposure to WTCD events is associated with high productivity loss at baseline, but not consistently at follow-up. Both PTSD and depression are associated with lower quality workdays at baseline and follow-up, but depression is more consistently associated with high work loss and medical service use. In multivariate analyses, WTCD exposure is associated with productivity loss at baseline, but less consistently at follow-up. At baseline, depression and history of traumatic events are associated with lower quality workdays and negative life events with greater workdays lost. Multivariate analyses at follow-up indicated that experiencing negative life events is associated with higher workdays lost and lower quality workdays and that PTSD is associated with lower quality workdays. Similar regression models suggested that increased outpatient service use is associated with depression and lifetime traumatic events at baseline and with negative life events at follow-up. CONCLUSION: This study suggests that while the WTCD had an impact on worker productivity within the first year after the attack, this did not generally persist, especially after controlling for baseline status. Having PTSD or experiencing stressful life events at follow-up, however, is associated with lower quality workdays, even after controlling for baseline status.

Adult↗
PubMed1997

Differences in the use of psychiatric outpatient services between the United States and Ontario.

BACKGROUND: The relation between health insurance and the use of mental health services is unclear. We compared the use of outpatient services for psychiatric problems in the United States and Ontario, Canada, among young and middle-aged adults according to self-reports of disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (third edition, revised) and to other indicators of need. METHODS: We analyzed two general-population surveys carried out separately in the United States and Ontario in 1990 that used identical assessments of need for services and questions about their use by persons 15 to 54 years of age. RESULTS: Respondents in the United States were significantly more likely than those in Ontario to report having had psychiatric disorders, poor mental health, or workdays lost or cut short because of psychiatric problems in the previous year. A significantly higher proportion of respondents in the United States (13.3 percent) than in Ontario (8.0 percent) had obtained outpatient treatment in the previous 12 months for psychiatric problems. However, an analysis of subgroups found that the higher probability of the use of services in the United States was confined to people with less severe mental illness. The average number of visits did not differ significantly between the two countries among patients who had similar numbers of psychiatric disorders over the same time periods. There was a stronger match in Ontario than in the United States between the use of services and the measures of perceived need we considered. CONCLUSIONS: Although the mental health care system in the United States provides treatment to a larger proportion of the population than that in Ontario, the match between some measures of need and treatment is not as strong in the United States. Any plans to expand coverage for psychiatric disorders in the United States must address this problem.

Adolescent↗
PubMed1993

Antitrust pitfalls in outpatient services.

Increasingly, services traditionally provided to inpatients are moving to the outpatient setting, resulting in greater antitrust risk. Antitrust issues are most likely to arise when a hospital with a large share of the inpatient market attempts to increase outpatient volume by restricting their patients' choices of outpatient providers, or when providers who control scarce outpatient resources attempt to restrict competition by denying other providers access to a facility. This trend has affected physicians both as competitors of hospitals in the outpatient services market and as participants with hospitals in ventures for the provision of outpatient care.

Ambulatory Care↗
PubMed1990

Utilisation of outpatient services at Red Cross War Memorial Children's Hospital, Cape Town.

The demand for outpatient services continues to grow at Red Cross War Memorial Children's Hospital (RCCH). To determine current utilisation patterns, we conducted a 2-week survey in the outpatient department (OPD). In addition, we reviewed the RCCH Annual Reports for the period 1961-1988. Annual outpatient attendances have increased from around 42,000 in 1957 to their highest level ever; nearly 350,000 in 1988. This steady rise in outpatient attendance was stemmed during the 1970s by the expansion of health services in the greater Cape Town area, in particular the introduction of day hospitals. In general, blacks are utilising the OPD as a primary community hospital for the treatment of infectious and environmentally induced diseases. In contrast, the white outpatient profile is more characteristic of a tertiary referral centre, with a higher proportion of specialist clinic attendances. The utilisation patterns for coloured children are intermediate. Analysis of the residential address of patients and their presenting diagnoses indicates an urgent demand for primary health care services in the most recently settled and poorest suburbs of Cape Town, many of which are remote from the hospital.

Black or African American↗
PubMedDate not supplied

Planning the provision of outpatient services in a rehabilitation clinic.

OBJECTIVE: This study had two aims: (1) to plan the provision of outpatient services in a rehabilitation clinic and increase the efficiency of these services; (2) to identify and evaluate criteria of good clinical practice in outpatient rehabilitation activities in order to avoid transforming the therapy into an assembly line in which the number of services is considered more important than the quality of services delivered. DESIGN: The authors identified the sequence of activities carried out for each of the services requested and monitored the number of appointments and treatments performed in two four month periods. As part of the process of increasing delivery efficiency and recording services provided, the authors created a computerised database for processing hospital charges. MAIN MEASURES: Quantitative comparison of services delivered during the 4 month sample periods in 1998 and 1999 and evaluation of compliance with identified indicators of good practice related to a series of rehabilitation outpatient therapies, divided into instrumental therapies and manual therapies. RESULTS: There was an increase in the number of appointments and services without an increase in the number of staff or clinics. In particular, the database introduced in March 1999 contributed to a further improvement with 692 appointments and 7517 therapies. Overall quality of practice was good, although privacy needs to be increased. CONCLUSION: The use of quality control instruments improved staff awareness of good clinical practice and highlighted some aspects which could be improved. The efficiency of the outpatient rehabilitation clinic increased.

Ambulatory Care↗
PubMed1998

Medicare program; prospective payment system for hospital outpatient services; extension of comment period--HCFA. Notice of extension of comment period for proposed rule.

This notice extends the comment period for a proposed rule published in the Federal Register on September 8, 1998, (63 FR 47552). In that rule, as required by sections 4521, 4522, and 4523 of the Balanced Budget Act of 1997, we proposed to eliminate the formula-driven overpayment for certain outpatient hospital services, extend reductions in payment for costs of hospital outpatient services, and establish in regulations a prospective payment system for hospital outpatient services (and for Medicare Part B services furnished to inpatients who have no Part A coverage.) The comment period is extended for 60 days.

Ambulatory Care↗
PubMed2003

Methods to determine private sector payment for VA outpatient services: institutional payments to providers.

OBJECTIVES: To describe methods used to estimate hospital institutional (facility) payments for providing Veterans Health Administration (VA) outpatient services. METHODS: A series of audits compared the accuracy of outpatient coding at six VA medical centers in federal fiscal year 1999 with private sector standards. Outpatient records were processed through industry standard software to determine validity and remove inappropriate services. Private sector payments were estimated by applying average payment data from Medicare cost reports and Medicare outpatient prospective payment schedules to counts of VA services. RESULTS: Coding audits found little difference in accuracy between VA and the community. Physician visits generated the most estimated payments and deviated most from Medicare payment experience. Radiology and laboratory services were the next highest expenditure categories for both the VA and Medicare. The proportion of radiology payments in VA data was notably lower and ambulatory surgery notably higher than Medicare's experience. Within major categories, the relative rankings of VA and Medicare services were consistent. DISCUSSION: Differences in payment criteria make exact cost comparisons of hospital-based and office-based settings difficult, particularly physician visits. Two VA clinical software applications, radiology and laboratory, provide information not readily convertible to a claims format; these applications need significant changes to be used for these purposes. They understate radiology services and overstate laboratory services compared with private sector standards. In addition, the laboratory application contains inappropriate or unspecified codes that cannot be accurately valued for many reasons.

Health Care Costs↗
PubMed2002

Satisfaction on outpatient services in hospitals of the Amhara Region.

A cross sectional survey was conducted to assess patients' satisfaction on outpatient services in the hospitals of the Amara Region. A total of 898 patients from nine hospitals were interviewed on exit. The majority (95.9%) had come due to illness, and of which, 53.2% had illnesses that lasted for more than 30 days. Among those who were sick, 47.5% were non-paying (free) patients. Long waiting hours during registration, visiting of doctors after registration, laboratory procedures, and revisiting of the doctors for evaluation with laboratory results and obtaining drugs from pharmacies were associated with dissatisfaction. When logistic regression was applied, waiting time for registration, physician consultation/examination, obtaining the prescribed drugs from the pharmacies, and overall time taken to receive prescriptions were associated with dissatisfaction. Among the sociodemographic factors, age was associated with dissatisfaction. More than one-third of the patients did not get the medications prescribed in the hospital pharmacies. Failure to find the prescribed drugs was associated with dissatisfaction. Unnecessary patient delays should be reduced to the minimum by assessing hospitals' processes. Ensuring drug supply with facilitated administrative processes is recommended.

Adolescent↗
PubMed1997

The impact of managed care on community mental health outpatient services in New York State.

This article explores the impact of managed care on community mental health outpatient services in New York State. A survey was sent to directors of all the licensed mental health organizations to obtain information about staff composition, services provided, training, funding, managed care affiliations, and advertising. The survey focus was on changes that had taken place in the past 4 years and those anticipated in the future due to managed care. Results indicate that managed care has led to changes in the aforementioned areas and that these changes varied by agency size, region, and type.

Ambulatory Care Facilities↗
PubMedDate not supplied

Adolescents' views of outpatient services.

This study used a qualitative, inductive method to seek out the perceptions of adolescents using the children's outpatient service in one general hospital. The views of seven young people attending clinics for chronic problems were obtained through taped, unstructured interviews. Four themes emerged which may give valuable insights into the needs of this age group in an outpatient setting. Implications for practice are discussed.

Adolescent↗
PubMed2004

Delivering an effective outpatient service in gynaecology. A randomised controlled trial analysing the cost of outpatient versus daycase hysteroscopy.

OBJECTIVE: To examine the cost implications of outpatient versus daycase hysteroscopy to the National Health Service, the patient and their employer. DESIGN AND INTERVENTIONS: Randomised controlled trial. SETTING: The gynaecology clinic of a large teaching hospital. PARTICIPANTS: Ninety-seven women with abnormal uterine bleeding requiring investigation. METHODS: Women were randomly allocated to either outpatient or daycase hysteroscopy. They were asked to complete diaries recording expenses and time off work. The National Health Service costs were calculated for a standard outpatient and daycase hysteroscopy. MAIN OUTCOME MEASURES: Costs to the National Health Service, costs to the employer, loss of income, childcare costs and travel expenses. RESULTS: The outpatient group required significantly less time off work compared with the daycase group (0.8 days vs 3.3 days), P < 0.001. Of those women who lost income due to the hysteroscopy, the average loss of income was twice as much in the daycase group ( pound 20.40 in the outpatient group vs pound 50.60 in the daycase group). The average cost of childcare required to cover the time spent in hospital undergoing the hysteroscopy was similar in both groups, however, the number of women requiring childcare was small. Travel costs incurred by the women were 74% more in the daycase group compared with the outpatient group-with an average cost of pound 3.46 in the outpatient group and pound 6.02 in the daycase group. Daycase hysteroscopy costs the National Health Service approximately pound 53.88 more per patient, than performing an outpatient hysteroscopy. Purchasing the hysteroscopes necessary to perform an outpatient hysteroscopy is a more expensive outlay than those required for daycase hysteroscopy. However, there are so many other savings that only 38 patients need to undergo outpatient hysteroscopy (even with a 4% failure rate) rather than daycase hysteroscopy in order to recoup the extra money required to set up an outpatient hysteroscopy service. CONCLUSION: Outpatient hysteroscopy offers many benefits over its traditional counterpart including faster recovery, less time away from work and home and cost savings to the woman and her employer and the National Health Service. Resources need to be made available to rapidly develop this service across the UK in order to better serve both patient and taxpayer.

Ambulatory Care↗
PubMed1991

Measuring hospital productivity and output: the omission of outpatient services.

A common measure of hospital productivity is the "cost per patient day". This measure, however, has a variety of drawbacks, one of which is its omission of outpatient care in the measure of hospital output, since a patient day is merely a measure of the volume of patient services, while the cost of outpatient services is included in the input. This study uses information from the Statistics Canada Annual Return of Hospitals to examine the volume of inpatient, outpatient and total patient services, to separate inpatient and outpatient costs and to study hospital productivity from 1976 to 1987-88 using both inpatient cost per patient day and outpatient cost per outpatient visit. Operating costs for Canadian public hospitals, in constant dollars, increased by 38.5% from 1976 to 1987-88. A large increase in hospital costs is not cause for concern unless costs are rising faster than hospital output. There does seem to be some indication that this is the case. The productivity of public hospitals in Canada, measured by "cost per patient day," has fallen by 19.8% from 1976 to 987-88. However, a major drawback to this measure of hospital productivity is that outpatient services were not included in the measure of output and therefore the productivity of hospitals is underestimated. When inpatient costs and services are separated from outpatient costs and services, inpatient services productivity as measured by inpatient cost per patient day still declines but only by 16.3%. On the other hand, outpatient cost per outpatient visit decreased by 2.3%, indicating an increase in productivity.

Canada↗
PubMed1984

Children who light fires: a comparison between firesetters and non-firesetters referred to a child psychiatric outpatient service.

This study compares firesetting children with an age- and sex-matched group of non-firesetting children referred to a child psychiatric outpatient service. Firesetting was associated with male sex, separated parents and with previous contact with welfare agencies. It was not associated with socioeconomic status. Firesetters were distinguished from the contrast group by higher levels of conduct disordered behaviour, particularly in children above the age of 11 years. Both groups had similar high levels of emotional disorder at all ages. These clinical features emphasise that firesetters have a mixed clinical picture with widespread psychopathology.

Adolescent↗
PubMed2001

Obesity in Austria: body mass index of 15 000 euthyroid men and women referred to a thyroid outpatient service between 1992 and 2000.

A mean body mass index (BMI) of 25.4 +/- 5.0 kg/m(2) was calculated in 15439 euthyroid patients newly referred to our thyroid outpatient department from January 1, 1992 until December 31, 1999. This patient population included 2916 men aged 50 +/- 16 years (BMI: 26.2 +/- 4.3 kg/m(2)) and 12563 women aged 47 +/- 17 years (BMI 25.3 +/- 5.1 kg/m(2) ). Mean BMI appeared to rise (p < 0.01) from 25.0 +/- 4.7 kg/m(2) (1992) to 25.6 +/- 5.0 kg/m(2) (1999) and the share of obese patients (BMI > 30 kg/m(2)) increased from 13.8% in 1992 to 17.2% in 1999. However these changes were parallelled by a rise (p < 0.01) in the mean age of newly referred patients from 45 +/- 16 years (1992) to 49 +/- 17 years (1999). When the whole population was subdivided into groups of different age no time-related trend was apparent in mean BMI or in the prevalence of obesity in any of these subgroups. Only in men and women beyond 60 years of age BMI of those referred in 1998 and 1999 was higher (p < 0.05) than in those individuals referred in 1992-1994. These data indicate that close to half of all euthyroid patients referred to a thyroid outpatient service in eastern Austria is overweight. From 1992 to the end of 1999 there was, however, no marked increase in the prevalence of obesity in this population.

Adult↗
PubMed1995

Quality of primary outpatient services in Dar-es-Salaam: a comparison of government and voluntary providers.

This study aimed to test whether voluntary agencies provide care of better quality than that provided by government with respect to primary curative outpatient services in Dar-es-Salaam. All non-government primary services were included, and government primary facilities were randomly sampled within the three districts of the city. Details of consultations were recorded and assessed by a panel who classed consultations as adequate, inadequate but serious consequences unlikely, and consultations where deficiencies in the care could have serious consequences. Interpersonal conduct was assessed and exit interviews were conducted. The study found that government registers of non-government 'voluntary' providers actually contained a high proportion of for-profit private providers. Comparisons between facilities showed that care was better overall at voluntary providers, but that there was a high level of inadequate care at both government and non-government providers.

Community Health Centers↗