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PubMed1997

High-quality television links for home-based support for the elderly.

Since 1991, 17 elderly people have been connected via a broadband video communication system to a telecare centre. The new services used videophones based on domestic television sets, including set-top boxes with cameras and a microphone. The services had the overall aim of promoting the ability of elderly and mobility-impaired people to live independently and to reduce the demand on social service resources required to implement this. Service components included: remote response to emergencies; active information and care; information and assistance service; remote care on demand; remote access to expertise (counselling); training and exercise service; and support for carers. Some 14,000 calls have been made. The important qualitative aspects were: clients' satisfaction; replacement of direct social contacts; privacy and data protection; and improving the effectiveness of social services. For a successful market implementation of video-based social support and telecare services, it is essential to integrate them into existing outpatient services.

Aged↗
PubMed1993

Rural hospital-based alcohol and chemical abuse services: availability and adoption, 1983-1988.

Data from a 1983-88 retrospective panel study of 797 rural (non-Metropolitan Statistical Area) U.S. hospitals revealed that less than one in five (18.7%) had any alcohol and chemical abuse (ACA) service. About one-third of both inpatient and outpatient services had been established during the study period, but few hospitals not offering these services planned to offer them in the immediate future. These findings support other studies that the availability of such services may not meet population need or demand, although non-hospital-sponsored services might partially fill the gap. Bivariate analysis showed that hospital locations in counties that were more densely populated, had higher per capita income and had more physicians per 1,000 population were positively associated with ACA services. Hospitals that were in the New England, Mid-Atlantic, East North Central census divisions, and were large according to number of beds, presence of psychiatric services, availability of psychiatrists and other nonphysician personnel, certain organizational arrangements and strategic management activities were positively associated with ACA services. Multivariable logistic regression suggested the presence of psychiatric services as a key correlate of ACA services, and the scarcity of psychiatric personnel in rural areas appears to have been a major reason for the infrequency of rural hospital-sponsored ACA services.

Alcoholism↗
PubMed1992

Meeting inspection requirements for outpatient imaging centers.

This article, by a manager of outpatient services, provides an overview of the inspection requirements for outpatient imaging centers. According to the author, while most freestanding centers are not currently inspected by the JCAHO, they must follow the guidelines of several other agencies. The author provides a list of 57 questions asked by JCAHO surveyors during a recent inspection of her facility.

Accreditation↗
PubMed2002

The 2003-2008 Australian Health Care Agreements: an opportunity for reform.

The Australian Health Care Agreements govern the relationship between the Commonwealth and States about public hospital funding. The incentives enshrined in the Agreements can shape policy priorities. Although they provide for the largest specific purpose grant a State/Territory receives, the current negotiations should not be seen as providing the only opportunity for reform of health care for the next five years. This paper argues that the negotiations should focus on two key areas where Commonwealth-State frictions are high but reform is feasible. Specifically it is suggested that the Commonwealth should contribute its funding of public hospital inpatient services on a casemix basis, and secondly, should fund outpatient services directly.

Ambulatory Care↗
PubMed2005

The lifespan merger sucess story: combining resources to offer better home health services.

In 1996, "Lifespan" was born when four home care agencies in Battle Creek, Michigan, merged to create a wholly owned subsidiary of the Battle Creek Health System (BCHS), a community health care delivery organization that provides acute care, long-term care, psychological services, outpatient care, home health care, and occupational and business services. By banding together to effect savings through joint contract purchasing and shared services, Lifespan and BCHS have formed a communal relationship that allows the two to offer a seamless continuum of care without establishing wholly discrete organizations. Lifespan has thus been free to independently make mutually beneficial partnerships with an information technology company to enhance patient care services to their clients.

Contracts↗
PubMed2000

The long-term effect of outpatient commitment on service use.

The long-term effect of outpatient commitment on service use was evaluated in 81 patients with serious and persistent mental illness. An increased number of outpatient visits and a decreased number of hospital admissions, total hospital days, and lengths of stay were observed during commitment periods of greater than 1 year relative to levels of use in the same patients over the 12-month period preceding commitment. This study provides support that outpatient commitment improves compliance with outpatient treatment and reduces hospital use in patients who are on outpatient commitment to a single treatment agency for periods up to 5 years.

Adolescent↗
PubMed1985

Development of a cost-efficient psychogeriatrics service.

Various cost-efficient and space-efficient methods were used to expand outpatient services to the elderly at a teaching hospital's psychiatry clinic over a 2-year period. During this time the active treatment census of elderly patients more than doubled, to 185 patients. Only one enrolled patient required psychiatric hospitalization, and none required nursing home placement in the 2 years. Except for the geriatrics service director, no new paid staff and no extra space were required to form the service. The authors review the methods that seemed most beneficial to the service.

Aged↗
PubMed1991

Disaggregated annual health services expenditures: their predictability and role as predictors.

Risk-based capitation payments are among the fastest growing modes of reimbursement for health insurance. There is ongoing debate about whether the usual underwriting factors such as age and sex are sufficient for establishing annual premiums. This study examines the predictability of disaggregated annual services expenditures and their potential as predictors. The results show that outpatient services are generally more predictable than inpatient services. According to elasticity calculations, prior-year own-expenditures are the strongest predictors of annual expenditures. Of the own-expenditure elasticities, those pertaining to total and outpatient charges are the largest. Among prior year cross-expenditure elasticities, outpatient drug and outpatient office visit expenditures are the greatest.

Adolescent↗
PubMed1986

A comparison of the effects of sociodemographic factors and health status on use of outpatient mental health services in HMO and fee-for-service plans.

The authors compared the effects of age, sex, socioeconomic status, and mental and physical health status on the use of outpatient mental health services in one well-established health maintenance organization (HMO) and in fee-for-service plans. In the Seattle site of the Rand Health Insurance Study (HIS), families were randomly assigned to HMO or fee-for-service coverage. Adults incur much greater expense for outpatient mental health services than children in both an HMO and a fee-for-service plan with identical coverage (i.e., free care). However, the difference in use between adults and children is significantly greater for the fee-for-service plan than the HMO (P less than 0.01). Similarly, education has significantly greater effects on use for the fee-for-service than the HMO plan. Increased income has a significant negative effect on use in both the HMO and fee-for-service plans. Mental and physical health status have similar large effects on use in both fee-for-service and HMO plans.

Adult↗
PubMed2001

Development of a patient-orientated instrument to measure service quality in outpatient departments.

AIMS OF THE STUDY: To describe three stages in the development of an instrument to measure service quality from the patients' perspective in hospital outpatient departments. RATIONALE: A reliable and valid service quality instrument is a valuable tool for collecting feedback from patients when improving outpatient services. DESIGN: A multiphase process with several versions of the questionnaire testing its validity and reliability. The first version of the questionnaire was constructed from information collected in a previous interview study of patients' service experiences. Using this version (47 questions) information was collected in 15 outpatient departments (314 patients) and the second version of the questionnaire was developed. At this stage, a survey of employees (n=111) was included in the development process. This second version of the questionnaire (43 questions) was used to collect more data in three outpatient departments of a university hospital and in two outpatient departments of two regional hospitals on three different occasions (1416, 369 and 124 patients) within a period of 2 years. The reliability of the instrument was tested in terms of stability by using three repeated measurements, and using the Cronbach's alpha coefficient as an indicator of internal consistency. Content validity was assessed by means of percentage agreement between staff and patients. Logistic regression analysis was performed to assess construct validity. RESULTS: The final version of the questionnaire contained 12 items. Agreement between patient and staff ratings was found to be acceptable for most questions (content validity). Two measurements on different occasions yielded a similar structure (construct validity). Internal consistency was acceptable (Cronbach's alpha = 0.67-0.93 in the first and 0.71-0.94 in the second survey). The variance of the alpha coefficients was small in the retest (stability). CONCLUSIONS: The instrument developed is general to the extent that it is suitable for assessing service quality improvement needs in individual units and for making cross-departmental comparisons.

Adult↗
PubMedDate not supplied

Mastering the Ambulatory Patient Groups system.

Providers and payers will need to implement the Ambulatory Patient Groups (APG) system, a complex new payment mechanism for outpatient care. Because the APG system consolidates, packages, and discounts a facility's payment for outpatient services, providers might receive decreased reimbursement for services, as compared to the reimbursement received under their present outpatient payment arrangements. APGs, like DRGs, will force providers to examine their coding practices carefully to ensure that they will receive reimbursement adequate to cover their costs.

Ambulatory Care↗
PubMedDate not supplied

Patients' satisfaction and importance ratings of quality in an outpatient oncology center.

Oncology patients requiring outpatient services have expectations that must be addressed to ensure continuous and improved quality of care. A convenience sample of 96 patients recruited from an oncology outpatient center completed a 26-item patient satisfaction questionnaire (SEQUS). Overall satisfaction ratings indicate that patients are satisfied with their care. Patients' perception of waiting time and lack of questioning regarding their medications by the pharmacist were identified as two areas needing improvement. Findings suggest that by identifying what is most important to patients, nurses can readily modify the care environment to enhance patient satisfaction and quality of care.

Appointments and Schedules↗
PubMed1990

Patients with multiple admissions in a psychiatric record linkage system.

Data from the Kingston Psychiatric Record Linkage System are used to examine the patterns of both inpatient and outpatient service utilization by patients with multiple admissions during a three year period compared with a control group with single admissions. The subgroup with drug and alcohol abuse disorders alone or in combination with a major functional disorder is examined in detail. An index of service utilization, which is based on aggregate inpatient stay and outpatient contacts, is calculated for each patient. Those with multiple admissions tend to be young, poorly educated, living alone and diagnosed with a major functional disorder; however, multiple regression analysis shows that other factors, as yet undetermined, contribute significantly to readmission. Among those with a major functional disorder, the subgroup of patients who also have drug and alcohol abuse disorders is particularly prone to multiple admissions. The need for specific services for patients with dual diagnoses is discussed. Early identification of those types of psychiatric patients who are likely to use services extensively is necessary to allow for planning and implementing of more cost-efficient and effective services.

Adjustment Disorders↗
PubMed1997

[Characteristics of private health care services in Salvador, Bahia, Brazil]

To study the organization of private health services in the city of Salvador, Bahia, Brazil, a survey was carried out in 1994 involving 174 facilities registered at the Brazilian Institute of Statistics and Geography - IBGE. Health services characteristics studied were the following: number of physicians, hospital beds, production and cost of outpatient services, and legislative aspects. Health services were classified according to the amount of resources each type of granting agency contributed to support outpatient care. We found that the majority (51.1%) of private health care services in Salvador do not depend on public funds. The main sources of revenue for health services are private health insurance (41.9%) and other kinds of private health plans (54%). These changes in the organization of health services challenge health planners to review strategies for municipalization of health care and the relations between public and private health services in Brazil.

Journal Article↗
PubMed2004

The value of your time: evaluation of effects of changes in medicare reimbursement rates on the practice of urology.

PURPOSE: Several reforms to Medicare have changed the reimbursement of physicians from payment based on usual, customary or reasonable charges to a resource based relative value scale. We studied the effect of these changes on hourly reimbursement rates for various services provided by urologists. MATERIALS AND METHODS: We used a previously published national survey of urologists who provided information regarding physician time and work required before, during and after most frequently performed urological services, including during the global period. For comparison mean operative times during the last year at our private hospital for several common urological procedures were obtained. Medicare reimbursement rates for common urological procedures and evaluation and management (E&M) codes for 1995, 1999 and 2004 were acquired from our department's billing office and used to calculate reimbursement rate per hour. RESULTS: There was a steady increase in reimbursement for outpatient services and a decrease in reimbursement for surgical procedures. For E&M codes the reimbursement rates per hour for 2004 represent a mean 51% increase since 1995. However, surgical procedures have had a mean decrease of 28.5% in reimbursement rates per hour. There was remarkable consistency in rates with 7 of the 9 surgical procedures losing between 25.5% and 32% in reimbursement. In 1995 outpatient E&M services were the least profitable at less than half the hourly rate of operative procedures. In 2004 office cystoscopy and transrectal ultrasound biopsy of the prostate had the highest reimbursement and, with the exception of shock wave lithotripsy, there was a minimal difference in hourly reimbursement rates between common surgical procedures and E&M services. CONCLUSIONS: Changes in Medicare reimbursement during the last decade have resulted in significant changes in rates for different urological services. The near equity in reimbursement rates for E&M and surgical services will likely have an increasingly important role in the future practice of urology.

Data Collection↗
PubMed2002

Predicting the use of outpatient mental health services: do modeling approaches make a difference?

Studies attempting to project the impact of providing health coverage to the uninsured population have demonstrated considerable variation in the estimated costs of mental health care. Different modeling approaches to project health care use and costs have been shown to address some data characteristics well, but not all of them. Using data from Health Care for Communities, a recent national household survey, this paper attempts to estimate and predict the use of mental health outpatient services if insurance coverage were extended to the uninsured. The study employs two-part models, with the second part based on an ordinary least squares (OLS) approach and a generalized linear model (GLM), and a zero-inflated negative binomial model (ZINB). Estimates and predictions are not sensitive to the modeling approaches chosen, although the ZINB model out performs the two-part models in terms of out-of-sample prediction.

Community Mental Health Services↗
PubMed1991

Outpatient psychogeriatric nursing services: an integrative model.

The complex needs of psychogeriatric patients and their families require specialized outpatient psychogeriatric services. The interaction of physical and mental health and the need for coordinated care places important responsibilities on nursing because it contributes to integrated, multidisciplinary care delivery to these patients and their families. This article presents a model of outpatient psychogeriatric nursing services focused on the community integration of patients and families. Experiences in the development of the Geriatric Neuropsychiatry Clinic at the University of Virginia, Charlottesville, are used as the point of departure from which to describe a model of outpatient psychogeriatric nursing care delivery that is multidisciplinary, clinically innovative, and epidemiologically justified.

Aged↗