Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “OUTPATIENT SERVICE”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
PubMed1993

[Management of infantile diarrhea by physicians in outpatient services in Peru].

This study investigated the practices followed by physicians in the clinical, therapeutic, and dietary management of children under the age of 5 with diarrhea. A total of 148 physicians were observed while they provided outpatient services at various public and private health institutions in two areas of Peru. They were also interviewed to assess their theoretical knowledge about the proper management of diarrhea in children. The physicians treated 222 children under 5 with diarrhea. It was observed that in taking their clinical histories the physicians ascertained the duration of the problem, the number of bowel movements, their consistency, and the presence of fecal mucus or blood in 175 (79%), 158 (71%), 140 (63%), and 153 (69%) cases, respectively. Antibiotics were prescribed for 130 children (58%), and 102 (46%) were not given any oral rehydration therapy (ORT). The oral rehydration salts (ORS) were recommended to only 40 (18%) of the children. On the other hand, during the interviews only 38 physicians (26%) indicated that they prescribe drugs for diarrhea, while 110 (74%) said that they recommend ORT. Fewer than half the mothers received recommendations regarding the type of food that they should give their children during the diarrhea episode. The results reveal a sizable discrepancy between theory and practice in the medical management of childhood diarrhea, which means that it is necessary to instill in physicians the importance of assessing and treating children with diarrhea according to a uniform and systematic scheme that includes careful therapeutic and dietary guidance.

Ambulatory Care↗
PubMed2001

The regulation of outpatient services: an analysis of the interaction between HCFA and Medicare providers.

The Federal Register is used as a historical record documenting the interaction between the Health Care Financing Administration (HCFA) and health care providers in the regulation of outpatient surgery services to Medicare patients. A content analysis of the Federal Register reveals that HCFA is more likely to accommodate requests for clarification, for shifting services among payment levels, and for adding or deleting services from coverage than for altering payment methods. These findings can be used by health care providers to develop strategies for coping with the expansion of prospective payment to all outpatient services.

Ambulatory Care↗
PubMed1997

The impact of aging and chronic disease on use of hospital and outpatient services in a large HMO: 1971-1991.

OBJECTIVES: To examine overall and diagnosis-specific trends in the use of inpatient and outpatient medical services (1970-1988) among older members of a large HMO. DESIGN: Two cohorts of approximately 3000 persons aged 65 or older in 1971 and 1980 were compared for hospital and outpatient utilization during 9-year follow-up periods (1971-79 and 1980-88). All subjects were evaluated for vital status throughout the follow-up period as well. PARTICIPANTS: All 6057 subjects were members of the Northern California Kaiser Permanente Medical Care Program in 1971 or 1980. The study sample was sex-age stratified (65-69,70-79,80+) at baseline. MEASUREMENTS: Data on demographics, outpatient health services utilization, categories of outpatient utilization and disease diagnoses were obtained from membership lists or medical chart review; inpatient utilization, including admitting and discharge diagnosis, length of stay, and number of hospital days was assessed from computerized hospitalization records. RESULTS: Hospital discharge rates (sex-age adjusted) increased by 12% between cohorts, with the largest increases at the oldest ages. There was a 25% increase among women and a 9% increase among men. Length of stay decreased by 20%. Hospitalization for ischemic heart disease decreased by 17%. Congestive heart failure (CHF) discharge rates (sex-age adjusted) were 92% higher in the 1980-88 cohort. For diagnoses related to nursing home institutionalization and frailty, discharge rates were significantly higher in the 1980-88 cohort: pneumonia (+34%), urinary tract infections (+104%), dehydration (+110%), osteoarthritis (+64%), syncope (+246%), leg cellulitis (+70%). In-hospital survival improved, but overall percent of readmissions also increased by 4%; readmissions for CHF increased by 13% and those for conditions of frailty by 120%. Overall outpatient visits increased by 17%. Use of laboratory tests (+57%) and outpatient surgeries (+99%) increased for all age strata in 1980-88 compared with 1971-79. CONCLUSIONS: While overall outpatient and inpatient utilization has largely decreased over the past 30 years, as a result of economic factors and improved treatments for some major diseases, there has been an increase in utilization among older people. Hospitalization for diagnoses associated with end-stage cardiovascular disease (CHF), musculoskeletal disease, frailty and iatrogenic aspects of institutionalization are clearly increasing substantially. The largest impact of aging on health care may be the result of institutionalization and its sequelae. Improved treatment for cardiovascular disease may also be leading to increased utilization at later stages in the disease process.

Aged↗
PubMedDate not supplied

Predicting rehospitalization and outpatient services from administration and clinical databases.

The study tests whether psychiatric services utilization may be predicted from administrative databases without clinical variables equally as well as from databases with clinical variables. Persons with a psychiatric hospitalization at an urban medical center were followed for 1 year postdischarge (N = 1384.) Dependent variables included statewide rehospitalization and the number of hours of outpatient services received. Three linear and logistic regression models were developed and cross-validated: a basic model with limited administrative independent variables, an intermediate model with diagnostic and limited clinical indicators, and a full model containing additional clinical predictors. For rehospitalization, the clinical cross-validated model accounted for twice the variance accounted by the basic model (adjusted R2 = .13 and .06, respectively). For outpatient hours, the basic cross-validated model performed as well as the clinical model (adjusted R2 = .36 and .34, respectively). Clinical indicators such as assessment of functioning and co-occurring substance use disorder should be considered for inclusion in predicting rehospitalization.

Adult↗
PubMed1998

Seroprevalence of human T cell leukaemia/lymphoma virus type I (HTLV-I) in pregnant women, patients attending venereological outpatient services and intravenous drug users from Slovenia.

To establish current seroprevalence of human T cell leukaemia/lymphoma virus type I (HTLV-I) infection in some low- and high-risk populations from Slovenia, 10,369 and 869 serum samples collected during Slovenian 1994 unlinked surveys of human immunodeficiency viruses seroprevalence in pregnant women and patients attending venereological outpatient services, respectively, and 219 serum samples collected from Slovenian intravenous drug abusers during 1995 and 1996, were screened for the presence of anti-HTLV-I antibodies using commercial particle agglutination test Serodia HTLV-I (Fujirebio, Tokyo, Japan). Only one sample obtained from a pregnant woman was found repeatedly positive in the screening test. Presence of anti-HTLV-I antibodies in the reactive sample was undoubtedly confirmed with supplemental Western blot test. The prevalence of antibodies to HTLV-I in the Slovenian population might be somewhere between one in 10,000 (0.01%) and one in 15,000 (0.0066%), which is similar or even higher to prevalence rates in other European countries.

Adolescent↗
PubMed1980

Results of a pilot management-by-objectives program for a community mental health outpatient service.

The challenge of the burgeoning complexity of administering mental health programs calls for increasingly sophisticated management strategies. Management by objectives is an administrative tool that may assist mental health managers in meeting administrative needs as well as service demands in a more efficient fashion. Management by objective is based on the principles of (a) stating objectives in measurable terms, (b) staff participation in decision making, and (c) performance-based rewards. This paper describes results of a pilot management-by-objective project applied to an outpatient service in a community mental health center.

Ambulatory Care↗
PubMed2006

Emergency outpatient services in the city of Berlin: Factors for appropriate use and predictors for hospital admission.

OBJECTIVES: To determine the proportion of patients making inappropriate use of medical care at hospital emergency rooms. To identify the factors that influence appropriateness of use and the probability of subsequent hospital admission. METHODS: Data were collected from 815 patients at three gynaecological/internal medicine emergency clinics in Berlin, Germany using multiple data sources: (i) standardized interviews covered service use history, psychosocial variables, migration history and sociodemographics; (ii) medical data were retrieved from patients' medical records, including case histories, diagnoses and therapies; (iii) emergency room physicians were asked to evaluate patients' language comprehension, physician-patient relationship and treatment urgency. Statistical analyses included chi tests, correlational and logistic regression analyses. RESULTS: According to a self-constructed index measuring appropriateness of emergency service use, about half of the patients' visits would have to be classified as inappropriate. Age, chronic illness and the time of day of the emergency service attendance were significantly associated with appropriateness of use. The probability of a hospital admission following the emergency treatment increased with patients' age and the physician's evaluation of treatment urgency. Remarkably, and contrary to the results of international studies, the patient's ethnicity played no significant role with respect to the appropriateness of use of emergency outpatient services or the likelihood of subsequent hospital admission.

Adolescent↗
PubMed2000

Medicare program; prospective payment system for hospital outpatient services: revisions to criteria to define new or innovative medical devices, drugs, and biologicals eligible for pass-through payments and corrections to the criteria for the grandfather provision for certain Federally Qualified Health Centers. Health Care Financing Administration (HCFA), HHS. Interim final rule with comment period.

This interim final rule with comment period changes one criterion and postpones the effective date for two other criteria that a new device, drug, or biological must meet in order for its cost to be considered "not significant" for purposes of determining its eligibility for transitional pass-through payments. It also changes the transitional pass-through payment policy to include new single use medical devices that come in contact with human tissue and that are surgically implanted or inserted in a patient whether or not the devices remain with the patient after the patient is released from the hospital outpatient department. These policies represent a departure from those presented in the April 7, 2000 Federal Register final rule with comment period entitled, "Prospective Payment System for Hospital Outpatient Services." This interim final rule with comment period also corrects a trigger date for grandfathering of provider-based Federally Qualified Health Centers (FQHCs) to conform with the intent not to disrupt existing FQHCs with longstanding provider-based treatment that we discussed in the April 2000 final rule. Under the criteria in the April 2000 final rule with comment period, FQHCs are treated as departments of a provider without regard to the criteria for provider-based status in that document if they meet other criteria and were designated as FQHCs before 1995. Under this correction, facilities that meet those other criteria and were designated as FQHCs or "look-alikes" on or before April 7, 2000 would continue to be treated as provider-based. In addition, we are clarifying how the requirement for prior notice to beneficiaries is to be applied in emergency situations. Also, we are clarifying the protocols for off-campus departments in emergency situations.

Ambulatory Care↗
PubMed2005

Use of antiplatelet therapy in a diabetic outpatient service of a large urban public hospital.

BACKGROUND AND AIM: Cardiovascular disease is the most important cause of mortality in type 2 diabetes. Aspirin treatment is effective in diabetic patients with cardiovascular disease and it does not significantly increase the risk of retinal haemorrhage, gastrointestinal bleeding or hemorrhagic stroke. The American Diabetes Association (ADA) recommends the use of aspirin in all adult patients with diabetes and macrovascular disease, and suggests to start treatment with aspirin for primary prevention in diabetic patients >or=40 years of age and with one or more other cardiovascular risk factors in the absence of specific contraindications. METHODS: In this observational retrospective study, we have selected from our database (17,732 clinical reports) all the type 2 diabetic patients 41--80 years of age, who had at least one visit to our outpatient service in the following two periods: A (from 1 July 1995 to 30 June 1996) and B (from 1 July 2002 to 30 June 2003), then analysed the patient-records for prescription of antiplatelet agents. RESULTS: Our analysis has shown that antiplatelet agents were prescribed to 15% of the type 2 diabetic patients in period A (10.8% and 53.4% -- primary and secondary prevention, respectively) and to 22.8% of the patients in period B (19.1% and 60.5% -- primary and secondary prevention, respectively). CONCLUSIONS: Patients with type 2 diabetes and high cardiovascular risk are not always under antiplatelet treatment despite the ADA recommendations, particularly for primary prevention. However, our data show an increased trend in prescriptions from 1997, when the first ADA specific guidelines for aspirin therapy were published.

Adult↗
PubMedDate not supplied

Hospital or health centre? A comparison of the costs and quality of urban outpatient services in Maseru, Lesotho.

Urban hospital outpatient clinics in developing countries are said to be overburdened and some policy experts are proposing a new intermediate tier of advanced health centres between hospitals and health centres to solve this problem (termed 'reference centres' by the World Health Organization). In Maseru, Lesotho, hospital congestion led the Ministry of Health to decide to build reference centres. To delineate precisely how these centres should operate, research was carried out on the existing system comparing utilization, quality and cost between health centre and hospital outpatient care. The study showed that throughout per clinician at the hospital and the city health centres was similar; that the hospital service saw a greater proportion of adults and more men; that the technical care quality was similar; and, that health centre staff took longer with patients and had higher interpersonal consultation scores. Average costs at the hospital were 39 per cent greater, but, the calculated net costs to the provider at the hospital and at government centres were very similar once user fees had been taken into account. The results questioned the assumptions underlying the decision to build reference centres in Maseru, and also the relevance of a new tier to solve health service delivery problems in the city. The study highlights the need for national and municipal planners to examine carefully existing health services with respect to utilization, quality and cost before adopting urban reference centres as a standard solution to congested hospitals.

Community Health Centers↗
PubMed2002

Providing patient choice: a nurse-led haematology outpatient service.

An autologous peripheral blood stem cell transplant service is now available on an outpatient basis for haematology patients in one trust. The nurse-led service provides patients with the benefits of being at home with their families, which improves their quality of life during treatment that often has unpleasant side-effects. The service also brings benefits for the trust.

Ambulatory Care↗