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 811 records · Page 45Linked to original sources
PubMedDate not supplied

[Social inequality in health and the utilization of health services among the elderly in Latin America].

OBJECTIVE: To learn if there is social inequality in health and in the utilization of health services among the elderly in six cities of Latin America: Buenos Aires, Argentina; São Paulo, Brazil; Santiago, Chile; Havana, Cuba; Mexico City, Mexico; and Montevideo, Uruguay. METHODS: This study used data from a project called Health, Well-being, and Aging in Latin America and the Caribbean (known as the "SABE project"). To investigate the presence of social inequality in health an ordinal probit model was used, with health status indicated by the following dependent variables: activities of daily living, instrumental activities of daily living, physical mobility, and self-rated health. To measure social inequality in the utilization of health services two characteristics were assessed: one for outpatient medical services (whether or not individuals received outpatient care, and how many times), and one for hospital admissions (whether or not individuals were hospitalized). For outpatient services, we estimated a negative binomial hurdle model, and for hospital admissions, a logit model was constructed. RESULTS: Our main results suggest the presence of social inequality in health in all the cities, with better-off socioeconomic groups having better health. The difference in health was less marked in Havana, Buenos Aires, and Montevideo, and it was more pronounced in São Paulo and Mexico City. With respect to the utilization of health services we found inequalities in the use of outpatient services in Santiago, Mexico City, and São Paulo. In Santiago and Mexico City, more schooling was associated with a higher number of expected outpatient medical visits; however, the opposite was found in São Paulo. For hospital admissions, inequality was found only in São Paulo, with individuals with more years of schooling being much more likely to be hospitalized. CONCLUSION: To a certain extent, our results reflect the socioeconomic and demographic characteristics of the countries in which each of the six cities is located. The cities in the countries with the worst social indicators (high income inequality and low human development index) tended to have the greatest inequalities in health and in the utilization of health services.

Age Factors↗
PubMed2004

Impact of atypical antipsychotics on quality of life, self-report of symptom severity, and demand of services in chronically psychotic patients.

OBJECTIVE: The study investigated whether the introduction of atypical neuroleptics in the formulary of a large community mental health clinic had any impact on demand for services, quality of life, symptom presentation and cost of care of patients with chronic psychotic illnesses over a 3-year period. METHODS: BJC Behavioral Health Services provides and coordinates mental health services for citizens residing in St. Louis City, St. Louis County and the counties of St. Francois, Iron and Washington, MO. We searched the BJC Behavioral Health Services and the Missouri Pharmacy Database to identify patients who had been switched from a typical to an atypical neuroleptic for a minimum of 3 months between 5/1/1997 and 4/30/2000. We excluded patients treated with more than one neuroleptic simultaneously and those with incomplete records. The primary outcome measures were: level of care assignment. Secondary outcomes were a quality of life scale, and a symptom severity inventory. Twenty-five patients met final entry criteria (out of a census of 6280 patients on 3/6/2000). RESULTS: In this naturalistic sample of patients with chronic severe psychotic symptoms, atypical neuroleptic treatment resulted in a marked reduction in demand of services, marked improvement on perception of quality of life, and a trend towards reduction in symptom severity, particularly in the cluster of affective symptoms of the SLSS, over a 3-year period. We also found that the cost of care after switching to atypical neuroleptics was increased, which coincided with increased number of services provided to the patients. These changes appeared to be the result of improved compliance with outpatient services such as follow-up visits and rehabilitative activities.

Adolescent↗
PubMed2005

Mental health care in Madrid.

AIM: To describe principles and characteristics of mental health care in Madrid. METHOD: Based on existing data, service provision, number of professionals working in services, funding arrangements, pathways into care, user/carer involvement and specific issues are reported. RESULTS: In Madrid, mental health services are organized into 11 zones/areas, divided into 36 districts, where there is a mental health outpatient service with a multi-disciplinary team. Home treatment and psychosocial rehabilitation services have been developed. Specialist programmes exist for vulnerable client groups, including Children and Adolescents, Addiction/Alcohol and Older People. The Madrid Mental Health Plan (2003-2008) is regarded as the key driver in implementing service improvement and increased mental health and well-being in Madrid. It has a meant global budget increase of more than 10% for mental health services. Results of the first 2 years are: an increase in mental health staff employed (17%), four new hospitalization units, 50% increase in places for children and adolescents Day Hospitals, 62 new beds in long care residential units, development of specific programmes for the homeless and gender-based violence, a significant investment in information systems (450 new computers) and development of best practice and operational guidelines. Mental health system was put to the test with Madrid's March 11th terrorist attack. A Special Mental Health Plan for Affected people was developed. DISCUSSION: Unlike some European countries, public mental health service is the main heath care provider. There are no voluntary agencies bcollaborating with mental health care. Continuity of care and coordination between all mental health resources is essential in service delivery. Increased demand of care for minor psychiatric disorders, children and adolescent mental health care, and implementation of rehabilitation and residential facilities for chronic patients are outstanding challenges similar to those in other European capitals. Overall, the mental health system had successfully coped with last year's increased care demand after March 11th terrorist attack in Madrid.

Adolescent↗
PubMed2002

Integrated fellowship in vascular surgery and intervention radiology: a new paradigm in vascular training.

OBJECTIVE: To evaluate an integrated fellowship in vascular surgery and interventional radiology initiated to train vascular surgeons in endovascular techniques and to train radiology fellows in clinical aspects of vascular diseases. SUMMARY BACKGROUND DATA: The rapid evolution of endovascular techniques for the treatment of vascular diseases requires that vascular surgeons develop proficiency in these techniques and that interventional radiologists develop proficiency in the clinical evaluation and management of patients who are best treated with endovascular techniques. In response to this need the authors initiated an integrated fellowship in vascular surgery and interventional radiology and now report their interim results. METHODS: Since 1999 vascular fellows and radiology fellows performed an identical year-long fellowship in interventional radiology. During the fellowship, vascular surgery and radiology fellows perform both vascular and nonvascular interventional procedures. Both vascular surgery and radiology-based fellows spend one quarter of the year on the vascular service performing endovascular aortic aneurysm repairs and acquiring clinical experience in the vascular surgery inpatient and outpatient services. Vascular surgery fellows then complete an additional year-long fellowship in vascular surgery. To evaluate the type and number of interventional radiology procedures, the authors analyzed records of cases performed by all interventional radiology and vascular surgery fellows from a prospectively maintained database. The attitudes of vascular surgery and interventional radiology faculty and fellows toward the integrated fellowship were surveyed using a formal questionnaire. RESULTS: During the fellowship each fellow performed an average of 1,201 procedures, including 808 vascular procedures (236 diagnostic angiograms, 70 arterial interventions, 59 diagnostic venograms, 475 venous interventions, and 43 hemodialysis graft interventions) and 393 nonvascular procedures. On average fellows performed 20 endovascular aortic aneurysm repairs per year. There was no significant difference between the vascular surgery and radiology fellows in either the spectrum or number of cases performed. Eighty-eight percent (23/26) of the questionnaires were completed and returned. Both interventional radiologists and vascular surgeons strongly supported the integrated fellowship model and favored continuation of the integrated program. Vascular surgery and interventional radiology faculty members wanted additional training in clinical vascular surgery for the radiology-based fellows. With the exception of the radiology fellows there was uniform agreement that vascular surgery fellows benefit from training in nonvascular aspects of interventional radiology. CONCLUSIONS: Integration of vascular surgery and interventional radiology fellowships is feasible and is mutually beneficial to both disciplines. Furthermore, the integrated fellowship provides exceptional training for vascular surgery and interventional radiology fellows in all catheter-based techniques that far exceeds the minimum requirements for credentialing suggested by various professional societies. There is a clear need for cooperation and active involvement on the parts of the American Board of Radiology and the American Board of Surgery and its Vascular Board to create hybrid training programs that meet mutually agreed-on criteria that document sufficient acquisition of both the cognitive and technical skills required to manage patients undergoing endovascular procedures safely and effectively.

Attitude of Health Personnel↗
PubMed1996

Day hospital/crisis respite care versus inpatient care, Part II: Service utilization and costs.

OBJECTIVE: The authors compared service utilization and costs for acutely ill psychiatric patients treated in a day hospital/crisis respite program or in a hospital inpatient program. METHOD: The patients (N = 197) were randomly assigned to one of the two programs and followed for 10 months after discharge. Both programs were provided by a community mental health center (CMHC) in a poor urban community. Data were collected for developing service utilization profiles and estimates of per-unit costs of the inpatient, day hospital, and outpatient services provided by the CMHC. RESULTS: On average, the day hospital/crisis respite program cost less than inpatient hospitalization. The average saving per patient was +7,100, or roughly 20% of the total direct costs. There were no significant differences between programs in service utilization or costs during the follow-up phase. Cost savings accrued in the index episode because per-unit costs were lower for day hospital/crisis respite and the average stay was shorter. Significant differences in cost were found among patient groups with psychosis, affective disorders, and dual diagnoses; psychotic patients had the highest costs in both programs. The two programs had roughly equal direct service staff and capital costs but significantly different operating costs (day hospital/crisis respite operating costs were 51% of inpatient hospital costs). CONCLUSIONS: The programs were equally effective, but day hospital/crisis respite treatment was less expensive for some patients. Potential cost savings are higher for nonpsychotic patients. Cost differences between the programs are driven by the hospital's relatively higher overhead costs. The roughly equal expenditures for direct service staff costs in the two programs may be an important clue for understanding why these programs provided equally effective acute care.

Adult↗
PubMed2005

Ask the children--auditing children's services with PALS standards.

Working together is a key element of the NHS Plan (DH 2000). The establishment of the Patient Advice and Liaison Service (PALS) presented staff at the Bournemouth and Christchurch Hospitals NHS Foundation Trust : with an opportunity to examine the experiences of children attending the outpatient department. An audit of outpatient services was undertaken using PALS national standards and the National Service Frame work for Children (DH 2003a). Parents reported receiving good information prior to and during the consultation but would like more written information to take home. The environment was rated positively but older children felt that the waiting area was lacking in appropriate activities to suit their needs. Very few respondents had heard of PALS and around half did not know who to approach with concerns.

Adult↗
PubMed2000

Know difference between APC coding systems.

You'll need to revise your chargemasters to include all of the evaluation and management CPT codes for emergency and clinic technical services to prepare for the Health Care Financing Administration's switch to ambulatory payment classifications for outpatient services. Physician- and hospital-generated CPT codes present different challenges. Physician CPT coding should never be performed on the higher-level visits without complete documentation of the higher-level visits. A descriptive patient classification system (PCS) does not accurately portray the intensity of the visit, but the quantified PCS lists specific nursing tasks and assigns a point value to each one.

Abstracting and Indexing↗
PubMed2000

Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2001. Health Care Financing Administration (HCFA), HHS. Final rule with comment period.

This final rule with comment period makes several changes affecting Medicare Part B payment. The changes include: refinement of resource-based practice expense relative value units (RVUs); the geographic practice cost indices; resource-based malpractice RVUs; critical care RVUs; care plan oversight and physician certification and recertification for home health services; observation care codes; ocular photodynamic therapy and other ophthalmological treatments; electrical bioimpedance; antigen supply; and the implantation of ventricular assist devices. This rule also addresses the comments received on the May 3, 2000 interim final rule on the supplemental survey criteria and makes modifications to the criteria for data submitted in 2001. Based on public comments we are withdrawing our proposals related to the global period for insertion, removal, and replacement of pacemakers and cardioverter defibrillators and low intensity ultrasound. This final rule also discusses or clarifies the payment policy for incomplete medical direction, pulse oximetry services, outpatient therapy supervision, outpatient therapy caps, HCPCS "G" Codes, and the second 5-year refinement of work RVUs for services furnished beginning January 1, 2002. In addition, we are finalizing the calendar year (CY) 2000 interim physician work RVUs and are issuing interim RVUs for new and revised codes for CY 2001. We are making these changes to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule also announces the CY 2001 Medicare physician fee schedule conversion factor under the Medicare Supplementary Medical Insurance (Part B) program as required by section 1848(d) of the Social Security Act. The 2001 Medicare physician fee schedule conversion factor is $38.2581.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

[The level of knowledge about different aspects of health of the population served in the Pedro Borras health area in the city of Pinar del Río].

A prospective study in order to determine level knowledge of the population about health, before and after the implantation of the Integral Medical Attention Programme to the Family, was carried out at the outpatient services in the "Pedro Borrás" Teaching Community Polyclinic Health Area. Of the population attending to this outpatient area, 917 individuals older than 15 years, were selected at random. These individuals were surveyed at the beginning of the study (November 1986), in order to collect data of main necessary aspects that the population must be acquainted with on health condition and health promotion, and were surveyed again after six months of the performance of the system (May 1987), and results of both surveys were compared and shown in tables with statistical data. The main programmes for health promotion before the implantation of the new system were, known, effectively, by the population in ratios ranging 0.26-0.49. After the performance of the new programme it was observed how the level of knowledge raises to 0.31-0.70, and knowledges on obesity and sedentary habits (0.69) and on prevention of accidents (0.70) becomes significative. We consider all these changes depending on a greater educational work by the physician and nurse in charge of the plan.

Cuba↗
PubMed1993

Survey of out-patient satisfaction in a general hospital.

This paper describes a brief questionnaire designed to assess patient satisfaction with outpatient services at a general hospital. Its application in the evaluation of services in a hospital in the Highland Area of Scotland is outlined, demonstrating how it can be used to highlight aspects of services that are satisfactory, and those that require improvement.

Adult↗
PubMed1985

Use of outpatient somatic health services by patients who use or need mental health services in three provider plans.

A major topic in mental health (MH) research addresses the problem that patients who use mental health services have inappropriately high levels of somatic use, and examines whether provision of mental health services can decrease the inappropriate use (the so-called offset effect). However, the research showing higher somatic use by mental health patients has usually been unable to control for the patients' health status, or for their mental health status. In this paper we examine use of somatic health services by enrollees in three provider plans as a function of both mental health use and mental health need. In two of the provider plans (an HMO and a prepaid independent practice association), MH users used significantly more outpatient somatic services than non-MH patients, after control for age and sex, and after control for the number of chronic conditions they had. People with MH need, however, did not use significantly more MH services than those without MH need. In the third plan, a Blue Cross/Blue Shield type of plan, results were different; MH users did not have significantly higher somatic utilization after control for chronic conditions, and those with MH need did have significantly higher somatic utilization after control for age and sex, but not after control for the number of chronic conditions. These results suggest that the form of inappropriate use of outpatient somatic services, and the nature of an offset effect, may be specific to the type of insurance provided.

Adult↗
PubMed1984

Effects of parental smoking on medical care utilization by children.

A household interview survey of 2,582 adult members of the Kaiser-Permanente Medical Care Program of Oregon conducted in 1970-71 contained detailed questions about cigarette smoking patterns. Detailed, computerized medical records were maintained for all inpatient and outpatient care rendered between 1967 and 1974 to the 1,761 children of the interviewed sample. Adjusted for age, family size, socioeconomic status, and duration of Health Plan membership, children in non-smoking households used significantly more outpatient services than did children in smoking households, a relationship largely accounted for by their use of more preventive medical services than by children in smoking households. There were no significant differences in inpatient medical care use and outpatient care use for respiratory illness by children of smoking and non-smoking households.

Adolescent↗
PubMed2002

Substitution in a Medicaid mental health carve-out: services and costs.

The objective is to empirically test the incentives associated with a Medicaid capitated mental health carve-out contract, whether outpatient services (less expensive, inside the contract) and residential treatment center care (costly care, outside of the contract) were substituted for inpatient psychiatric hospitalization used by children and adolescents. Data sources include Medicaid fee-for-service (FFS) claims for the non-capitated comparison sites and for residential treatment center use, and "shadow billing" encounter data for the experimental capitated managed care sites that provided public mental health services for children and adolescents with Medicaid insurance statewide in Colorado from September 1994 to June 1997. Two part least squares regression models are used to decompose services. Managed care sites are compared to sites that remained under FFS financing, before and in two post-periods after the carve-out. Principal findings show that children and adolescents who received mental health services from a capitated managed care provider were significantly less likely to receive inpatient care, and significantly more likely to receive residential treatment center care. In addition, insurance contract design contains financial incentives that affect the amount and mix of clinical care provided to clients by risk-bearing provider agencies. Findings provide evidence of cost substitution from inpatient care both inside the specialty system and outside the carve-out to other child-serving systems.

Adolescent↗
PubMed1994

Public outpatient mental health services: use and outcome among Asian Americans.

Use of public outpatient mental health services and treatment outcomes were studied among Chinese, Japanese, Filipino, Korean, and Southeast-Asian Americans in Los Angeles County. Filipinos were underrepresented in the system, whereas Southeast Asians were overrepresented and had higher utilization rates, but showed less improvement, than did the other groups. The influence of therapist-client ethnic match and of clinicians' professional status were assessed, and recommendations are made for further research based on present findings.

Acculturation↗
PubMed1985

Coverage and patterns of ambulatory medical care use in Tlalpan, Mexico City.

Health officials planned a stepped care system (regionalized) for Tlalpan, in the Federal District of Mexico (D.F.), to address problems of duplicated services, inappropriate use of available resources, increasing costs of medical care, and unmet health needs in the population. Cross-sectional surveys were carried out in the community, in health centers and in hospital based ambulatory services (outpatient department and emergency department) to obtain current, specific and valid information about need and utilization patterns. Users of the various services differed from each other and from the community by age, educational level, occupation, rights to prepaid care and utilization patterns. Emergency department users came back for care repeatedly and sought preventive services from the emergency department. Major reasons for attending the emergency department included respiratory and gastrointestinal problems, plus poisonings, accidents, and complications of pregnancy. Outpatient department users arrived without referral from medical sources and continued to return frequently for care. Users were mostly adults, particularly older adults, with problems of a more chronic nature, e.g. nervous system problems, genitourinary problems, etc. The health centers attended clients from the designated area of influence who had referred themselves to the center for care. Children were the most frequent clients with acute, common problems, e.g. diarrhea and respiratory problems. Health maintenance activities were assessed for which children received the most complete coverage, but some women lacked the necessary care for perinatal health and family planning. In general, health centers seemed to be functioning appropriately, although the magnitude of unattended need in their areas of influence must be investigated further.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Acute lung inflammation: neutrophil elastase versus neutrophils in the bronchoalveolar lavage--neutrophil elastase reflects better inflammatory intensity.

OBJECTIVE: To test the hypothesis whether PMN-Elastase in bronchoalveolar lavage fluid (BALF) could reflect neutrophil activity in the lower respiratory tract. DESIGN: Prospectively, morphologic findings of acute and chronic inflammation in the transbronchial lung biopsy specimens were compared with the numbers of neutrophils in the BALF and the concentration of PMN-Elastase in the same. SETTING: Ambulatory outpatient service of bronchology and respiratory physiopathology and intensive care unit of a communal hospital. PATIENTS: 50 ambulatory outpatients and 10 critically ill patients of the ICU, presenting infiltrative lung diseases. INTERVENTIONS: Transbronchial lung biopsies and bronchoalveolar lavage were performed through a fiberoptic bronchoscope. Venous blood samples were obtained after bronchoscopy. MEASUREMENTS AND RESULTS: Biopsy specimens and cell count in the BALF were examined by light microscopy. PMN-Elastase and albumin were measured in the BALF-supernatant and in the plasma. C-reactive protein (CRP) and a1 proteinase inhibitor (a1-PI) were measured in the plasma. Intrapulmonary originating PMN-Elastase was calculated with reference to albumin. The results concerning acute inflammation obtained by transbronchial lung biopsy (TBLB) (n = 16) correlated better with the levels of PMN-Elastase in the BALF (n = 21) than with the neutrophil count (n = 28) (p < 0.5 versus p < 0.025 for chi 2). The sensitivities and specificities of the above methods were respectively 76.9%, 100%, 100% and 100%, 95.2%, 63.1%. The intrapulmonary originating PMN-Elastase was about 99.7% of the measured BALF-Elastase. CONCLUSION: The PMN-Elastase concentration in the BALF is a more accurate indicator of the inflammatory intensity in the alveolar structures than in the number of neutrophils. It may therefore be useful to the clinician in his attempt to detect acute inflammation in the lower respiratory tract.

Acute Disease↗
PubMed1989

Integration of general hospital psychiatric services with freestanding psychiatric hospitals.

General medical hospitals and freestanding psychiatric hospitals usually function independently. The authors review the relative strengths and weaknesses of the two settings and suggest a plan for a rational coordination of services. In an efficient integrated system, the general hospital would provide emergency psychiatric services and treat patients with combined medical and psychiatric conditions. The freestanding facility would offer inpatient and outpatient services, as well as partial hospitalization and transitional living arrangements, to psychiatric patients without medical complications. All facilities would share professional staff and data processing capabilities and would have common policies and procedures, reducing the cost of treatment and facilitating patient transfers.

Hospital Bed Capacity, 100 to 299↗
PubMed1996

Elements of a successful short-stay inpatient psychiatric service.

In 1989 Johns Hopkins Hospital modified the Meyer 3 short-stay psychiatric service, which has allowed the hospital to comply with state requirements to control inpatient costs and has increased revenues. Strategies and organizational changes that were implemented to reduce length of stay include use of a screening tool by the admitting physician to ensure appropriate referrals to the service, modification of morning and afternoon rounds and strengthening of linkages with the psychiatric emergency department and outpatient services to enhance communication, replacement of inexperienced first-year residents in the emergency department with senior residents on 24-hour call who are closely supervised by short-stay service staff, and enhanced training for service nurses. Patients who are functionally disabled and who need assistance in activities of daily living have longer stays. Patients with substance use disorders are now referred to an ultra-short-stay unit.

Activities of Daily Living↗