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Scriba PC. Future development of hospital structure. Dtsch Med Wochenschr 2004; 129:1181-2. [PMID: 15160320 DOI: 10.1055/s-2004-824867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
BACKGROUND Inappropriate medication use in elderly patients has been linked to a large share of adverse drug reactions and to excess health care utilization. METHODS Trends in the prevalence of potentially inappropriate drug prescribing at ambulatory care visits by elderly persons from 1995 to 2000 were examined with data from office-based physicians in the National Ambulatory Medical Care Survey and from hospital outpatient departments in the National Hospital Ambulatory Medical Care Survey. Explicit criteria were used to identify potentially inappropriate prescribing. Multivariate regression was used to identify related factors. RESULTS In 1995 and 2000, at least 1 drug considered inappropriate by the Beers expert panel was prescribed at 7.8% of ambulatory care visits by elderly patients. At least 1 drug classified as never or rarely appropriate by the Zhan expert panel was prescribed at 3.7% and 3.8% of these visits in 1995 and 2000, respectively. Pain relievers and central nervous system drugs were a large share of the problem. The odds of potentially inappropriate prescribing were higher for visits with multiple drugs and double for female visits. The latter was due to more prescribing of potentially inappropriate pain relievers and central nervous system drugs. CONCLUSIONS Potentially inappropriate prescribing at ambulatory care visits by elderly patients, particularly women, remains a substantial problem. Interventions could target more appropriate drug selection by physicians when prescribing pain relievers, antianxiety agents, sedatives, and antidepressants to elderly patients. Such behavior could eliminate a large portion of inappropriate prescribing for elderly patients and reduce its higher risk for women.
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Caduff F, Georgescu D. Consultation-liaison psychiatry in Switzerland. ADVANCES IN PSYCHOSOMATIC MEDICINE 2004; 26:25-30. [PMID: 15326859 DOI: 10.1159/000079758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Morera-Guitart J, Pedro Cano MJ. [Variation in the pathology attended in out-patient Neurology Clinics: a demented future]. Neurologia 2003; 18:417-24. [PMID: 14615943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
INTRODUCTION We analyze the changes observed between 1996 and 2001 in the distribution of the pathology attended and the follow up model used by the out-patient Neurology Clinic in the Marina Alta area, in order to confirm possible variations that may have repercussions for Human Resource needs in the provision of adequate neurological care. METHODS We prospectively registered the attendance records for visits made to the Out-patient Neurology Clinic of Marina Alta in 1996. The variation coefficients between both series were calculated and compared. RESULTS The average age of patients increased in 5 years. The number of patients attended increased 42.3%, new patients 40%, visits 13%, the "Review visit/First Visit" ratio reduced 29%. The attendance of patients with Cognitive Impairment (Cog. Imp.) doubled. There were no changes in the origins of the patients. Requests due to Cog. Imp. and parkinsonism increased significantly from Primary Care and Emergency Department. The delay to be attended increased 23%. Discharges increased 43.9%, highlighting an increase of 144% observed in the Cog. Imp. group. CONCLUSIONS Changes have been observed in: the age of the population studied; the follow up of patients; the delay in attending them; and the pathology attended, with a significant increase in demand due to neurodegenerative pathology (especially Cog. Imp.). All this requires an increase in care needs that the Health Service has not been able to assume, creating an incongruous care model: we suggest a direct follow up model and offer a consultancy model.
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Abstract
INTRODUCTION The latest government targets state that by the end of 2005 the maximum waiting time for an outpatient appointment will be 3 months. These recommendations will not only increase the size of the outpatient clinics, but also the resources required thereafter. The purpose of this study was to analyse the outcome of new patient referrals to one knee outpatient service in order to quantify the resources required to investigate and treat these patients. METHOD All new patients attending one consultant's knee outpatient service in the time period January 1st 1997 to December 31st 1997 were prospectively entered into a database recording patient details, source of referral and diagnosis. Eighteen months after the time period a cohort of 200 patients was randomly selected and the case notes were analysed. The number of outpatient appointment episodes, MRI scans, physiotherapy referrals and surgical episodes generated were recorded for each patient. RESULTS Analysis of the initial database records show that a total of 662 new knee referrals were seen in 1997. Fifty-two percent (341) were made up of the five most common diagnoses, these being osteoarthritis, anterior knee pain, anterior cruciate ligament injury, medial ligament injury and medial meniscus injury. Retrospective analysis of the 200 patient notes revealed that these patients required a total of 499 outpatient episodes, 43 MRI scans, 180 courses of physiotherapy and 93 surgical episodes (53 elective and 40 emergency). These figures can be used to predict the resources that would be required by all new patients seen in an outpatient knee service in a year. DISCUSSION Each new patient that enters the cycle of investigation followed by treatment must be met by extra resources. If this does not occur the net result will be that although government targets may be met, the time taken to complete each patient episode will become longer. It is imperative that before an agreement is made to see new patients the resources required to manage them are in place.
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Worrell B. Fitness/wellness centers promote healthy bottom line. HEALTH CARE STRATEGIC MANAGEMENT 2002; 20:1, 12-5. [PMID: 12385284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Sills MR, Bland SD. Summary statistics for pediatric psychiatric visits to US emergency departments, 1993-1999. Pediatrics 2002; 110:e40. [PMID: 12359813 DOI: 10.1542/peds.110.4.e40] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe characteristics of emergency department (ED) encounters for pediatric patients with an acute mental health diagnosis. METHODS Data are from the National Hospital Ambulatory Medical Care Survey, which includes abstracts from the medical records of a national probability sample of visits to EDs. Analysis was limited to records of patients who were younger than 19 years and had a diagnosis of either confirmed or suspected mental disorder or a suicide attempt. RESULTS There was an estimated annual average of 434 000 ED pediatric mental health visits from 1993 to 1999, an average annual rate of 326.8 visits per 10 000 people. Visit rates varied by patient's region, age, race, and gender. Psychosis was the diagnosis in 10.8% of these patients, and suicide attempt was the diagnosis in 13.6%. ED pediatric mental health visits accounted for 1.6% of all ED visits in this age group. CONCLUSIONS The significant increase in emergency department pediatric mental health (EDPMH) visits from 1993-1999 is greatest among patients who are non-white, teenaged, female, and live in the Northeast or Midwest. This variation in EDPMH visits may reflect variability in the shortage of mental health providers. The lack of increase in the 2 categories of diagnoses mandatorily seen in EDs--psychoses and suicide attempts--suggests that the overall rise in EDPMH visits may have been attributable to nonurgent complaints more appropriately managed by a primary mental health provider.
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Lynk WJ, Longley CS. The effect of physician-owned surgicenters on hospital outpatient surgery. Health Aff (Millwood) 2002; 21:215-21. [PMID: 12117132 DOI: 10.1377/hlthaff.21.4.215] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hospitals increasingly find themselves subject to competition from freestanding outpatient treatment facilities such as diagnostic imaging centers and ambulatory surgery centers. That competition causes hospitals particularly intense concern when the freestanding facility is owned by physicians who are on the hospital's medical staff. We find some basis for that concern. Further, this particular form of rivalry raises competitive complications that differentiate it from the standard antitrust analysis of new competitive entry.
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Adelhard K, Matzko M, Brüning R, Holzknecht N, Stark V, Reiser M. [University clinics as centers of radiologic performance alliances in the ambulatory and inpatient sector]. Radiologe 2002; 42:82-6. [PMID: 11963252 DOI: 10.1007/s00117-001-0695-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PROBLEM Health care delivery in Germany has to face severe challenges that will lead to a closer integration of services for in- and out-patients. University hospitals play an important role due to their activities in research, education and health care delivery. They are requested to promote and evaluate new means and ways for health care delivery. METHODS The Institute of Clinical Radiology at the University Hospital of the Ludwig-Maximilians-University started teleradiological services for hospitals and general practices in January 1999 in the framework of the "Imaging services--teleradiological center of excellence". Legal, technical and organizational prerequisites were analyzed. RESULTS Networks between university hospitals and general practices are not likely to solve all future problems. They will, however, increase the availability of the knowledge of experts even in rural areas and contribute to a quality ensured health care at the patients home. Future developments may lead to international co-operations and such services may be available to patients abroad. CONCLUSION Legal, technical and organizational obstacles have to be overcome to create a framework for high quality telemedical applications. University hospitals will play an important role in promoting and evaluating teleradiological services.
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Gyr N, Zeller A, Battegay M. [The Basel Medical University Polyclinic on the brink of the 21st century: retrospective and prospective view]. PRAXIS 2001; 90:1387-1397. [PMID: 11552319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
At the occasion of its 125th anniversary the outpatient department of internal medicine is being analysed with regard to its history, development and future. Originally it was founded to improve practical patient-oriented teaching of students and to serve the poor population of Basel. While today the Swiss Health Insurance system warrants proper care for every citizen and thus renders the latter purpose unnecessary, new marginal patient groups have evolved that need proper attention such as HIV patients, asylum-seekers, geriatric patients and others. Teaching obligations have even increased, especially with regard to primary care and family medicine. Thus the reasons for running a medical outpatient department have changed considerably, but still include teaching, research and provision of care to special patient groups. Outpatient departments have to be flexible and to adapt to modern trends in health care.
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McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 1999 emergency department summary. ADVANCE DATA 2001:1-34. [PMID: 12666256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVES This report describes ambulatory care visits to hospital emergency departments (ED's) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Highlights of trends in ED utilization from 1992 through 1999 are also presented. METHODS The data presented in this report were collected from the 1999 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability survey of visits to hospital emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. Trends are based on NHAMCS data for 1992, 1993-94, 1995-96, 1997-98, and 1999. RESULTS During 1999, an estimated 102.8 million visits were made to hospital ED's in the United States, about 37.8 visits per 100 persons. The volume of ED visits increased by 14 percent from 1992 through 1999, though no trend was observed in the overall population-based visit rates. There was a significant increase in the visit rate for black persons 75 years of age and over. In 1999, persons 75 years of age and over had the highest ED visit rate and 41.5 percent of these patients arrived by ambulance. There were an estimated 37.6 million injury-related ED visits during 1999, or 13.8 visits per 100 persons. Seventy-four percent of injury-related ED visits were made by persons under 45 years of age. Injury visit rates were higher for males than females in each age group under 45 years. The case mix of visits at ED's changed since 1992, with a greater percent of visits presenting with illness rather than injury conditions. Abdominal pain, chest pain, fever, and headache were the leading patient complaints accounting for one-fifth of all visits. Acute upper respiratory infection was the leading illness-related diagnosis at ED visits. Increases were observed in visits where no complete diagnosis could be made (16.2 percent of visits in 1999). Diagnostic and/or screening services were provided at 89.0 percent of visits, procedures were performed at 42.5 percent of visits, and medications were provided at 72.5 percent of visits. Pain relief drugs accounted for 31.1 percent of the medications mentioned. Trend data from 1992 indicated that the use of medications at ED visits increased. In 1999, approximately 13 percent of ED visits ended in hospital admission. Facility-level data indicated that there is variation among hospital ED's with respect to case mix, number of services provided, and case disposition distributions, especially the percent admitted to the hospital.
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Abstract
Overall morbidity and mortality rates are higher among Aboriginal people than in the general Australian population. It is unclear, however, whether this is because of general poor health or a minority with very high levels of disease within a reasonably healthy Aboriginal community. At Cherbourg Community, almost all health care is given by the hospital. All visits to the casualty/outpatient departments at the hospital have been recorded since 1993. These data have been analysed to find the patterns of visiting by person, by diagnosis and by year. Over the 5 years with complete data, most people made less than five visits per year (low visit group) to the hospital ambulatory clinic, but at the other extreme, approximately 14% of people made 50% of the visits (high visit group). People who made many visits in 1 year made approximately three times as many visits as the low visit group in other years. When the high and low visit groups were compared, the high visit group was more likely to be female and to come for problems related to infection, but were less likely to come with injuries or accidents. The age distribution was similar in both groups. If the number of visits to a health service is an indicator of health, then most Aboriginal people at Cherbourg have reasonable health, but a sizeable minority have health problems that extend over several years. This group skews the overall statistics of Aboriginal health and should be targeted for extra attention.
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Zimmerman CM, Bresee JS, Parashar UD, Riggs TL, Holman RC, Glass RI. Cost of diarrhea-associated hospitalizations and outpatient visits in an insured population of young children in the United States. Pediatr Infect Dis J 2001; 20:14-9. [PMID: 11176561 DOI: 10.1097/00006454-200101000-00004] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the financial and clinical burden of diarrhea- and rotavirus-associated disease among a population of privately insured US children. METHODS For the period 1993 through 1996, we analyzed medical claims data from a large, administrative database containing information on approximately 300,000 children <5 years of age to examine trends in, and costs associated, with hospitalizations and outpatient visits for diarrhea. RESULTS An annual average of 1,186 diarrhea-associated hospitalizations (35 per 10,000 children <5 years) and 33 386 outpatient visits (943 per 10,000 children <5 years) were reported, accounting for 4% of all hospitalizations and 2% of all outpatient visits among children <5 years of age. Diarrhea-associated hospitalizations and outpatient visits showed a distinct winter-spring peak consistent with that of rotavirus infection. The excess of diarrhea-associated events occurring during the winter-spring peak accounted for an average of 50% of all diarrhea-associated hospitalizations and 18% of all diarrhea-associated outpatient visits. The median cost (in 1998 constant dollars) of a diarrhea-associated hospitalization was $2,307, and that for a rotavirus-associated hospitalization was $2,303. Median costs of diarrhea- and rotavirus-associated outpatient visits were $47 and $57, respectively. CONCLUSIONS Diarrhea is an important cause of morbidity in this insured population of young children. The epidemiologic features of diarrhea-associated events suggest that rotavirus is an important contributor to the overall morbidity from diarrhea. These disease burden and cost estimates should provide useful information with which to assess the costs and benefits of future interventions for rotavirus-associated illness.
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Abstract
Our objective was to compare a brief, relatively new global health status measure, the Health Utilities Index Mark II (HUI), to two commonly applied health status measures (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36] and the Sickness Jgipact Profile [SIP] in a general medical outpatient population. Using a cross-sectional survey, we surveyed 160 patients in the General Medical Clinic of the Durham Veterans Affairs Medical Center. Each subject answered demographic questions and then completed the three health status measures. The mean tJgie taken to complete the measures was 3, 10, and 20 minutes for the HUI, SF-36, and SIP, respectively (p <.0001). The HUI exhibited a modest "floor" effect; that is, scores were concentrated near the sicker of the scale. In contrast, responses to the SIP were heavily concentrated near the healthier end of the scale. Spearman correlation coefficients between the HUI and scales within the other two measures ranged from. 54 (SF-36 mental health) to 0.69 (SF-36 physical functioning). Subjects accepted all measures well. These three health service measures varied in their distribution of responses and ttime required to complete. Users should consider the degree of sickness of the population to be assessed when choosing a measure.
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Franco SJ. Implications of the BBA for rural hospitals. POLICY ANALYSIS BRIEF. W SERIES 1999; 2:1-4. [PMID: 11764814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Zuckerman AM. Where does ambulatory care fit in your hospital's integrated delivery system? AMBULATORY OUTREACH 1999:29-31. [PMID: 10350852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Hallam K. Estimated losses from outpatient PPS rise. MODERN HEALTHCARE 1999; 29:3, 12. [PMID: 10387869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Abstract
This study evaluates trends in efficiency among American hospital markets. A total of 6010 hospitals were identified for use in the analysis from the American Hospital Association's Annual Surveys for 1989 and 1993. Using data envelopment analysis (DEA), a longitudinal study of hospital efficiency was conducted on all 314 metropolitan markets in the United States. Results suggest that large hospital markets generally demonstrated higher inefficiency. The major inefficiencies exist in the availability of hospital services, the number of operating beds, the utilization of hospital staffing and operating expenses. Consequently, the large hospital market had a significant excess of health manpower that resulted in inefficiency that amounted to approximately $23 billion. From a policy perspective, this study has shed some light on the need to establish more specific policies to address inefficiency in the health care industry.
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Brown E. Complementary and alternative medicine. The daunting challenge. PHYSICIAN EXECUTIVE 1998; 24:16-21. [PMID: 10351710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
There is no question that the past few years have seen a tremendous surge in interest in what has come to be known as complementary and alternative medicine (CAM). Health plans contemplating adding CAM benefits face a daunting challenge. How should a plan define CAM benefits? How should a plan define appropriate CAM providers? How can these benefits be managed? Will the addition of CAM benefits undermine coverage policies for conventional biomedicine? The answer to these questions lies largely in uncharted waters, as even CAM advocates will agree that many alternative therapies (even those like Oriental medicine which has been in practice for some 5,000 years) have not yet undergone the type of rigorous, evidence-based analysis that is required to validate conventional biomedicine. This article explores options for CAM benefit design by considering two basic approaches-creating an uninsured benefit or insured benefit.
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Croft AM, Lynch P, Smellie JS, Dickinson CJ. Outpatient waiting times: indicators of hospital performance? J ROY ARMY MED CORPS 1998; 144:131-7. [PMID: 9819719 DOI: 10.1136/jramc-144-03-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We monitored outpatient waiting times at UK military hospitals over an 18-month period (September 1996-March 1998). The highest mean waiting times for Consultant appointment were in urology (19 weeks) and orthopaedics (18 weeks). The lowest mean waiting times were in psychiatry (3 weeks), ENT surgery (5 weeks) and rheumatology (6 weeks). Waiting times for surgical specialties were around 50% higher than for medical specialties. The inter-hospital variability in waiting times was 260%. Military waiting list initiatives were introduced in 4 key specialties, but the majority of these initiatives only had a temporary impact in reducing outpatient waiting times. Waiting times reflect the accessibility of a hospital's services, and are a crude but easily measured indicator of one aspect of patient care. With a military population base, outpatient waiting times should be reduced to the lowest practicable level. The keys to achieving a long-term reduction in waiting times are proper staffing levels and the efficient management of clinics.
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Dahler-Eriksen BS, Lassen JF, Lauritzen T, Lund ED, Brandslund I. [Differences in the use of C-reactive protein analysis and erythrocyte sedimentation in general practice and hospitals. Development from 1986 to 1995]. Ugeskr Laeger 1998; 160:4868-72. [PMID: 9741253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Analysis for C-reactive protein (CRP) was introduced in the Vejle Hospital catchment area in 1987. During the next ten year period the use of CRP has increased to reach a stable level both on hospital wards, out-patient clinics and in general practice. While the use of erythrocyte sedimentation rate on wards has decreased correspondingly, this is not seen in out-patient clinics or in general practice. There are medical as well as practical reasons for this discrepancy. It is believed that the possibility of performing a CRP as a point-of-care test in the GPs office in the future will lead to a reduction in the number of analyses of erythrocyte sedimentation rate performed in general practice as well.
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Moy E, Bartman BA, Clancy CM, Cornelius LJ. Changes in usual sources of medical care between 1987 and 1992. J Health Care Poor Underserved 1998; 9:126-39. [PMID: 10073198 DOI: 10.1353/hpu.2010.0305] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study is a secondary analysis of data from the 1987 and 1992 National Health Interview Surveys. Analyses compared adults who do not have a usual source of care and those who identified usual sources of care in 1987 and 1992. Between these years, the estimated number of adult Americans without a usual source of care rose from 29.7 to 39.4 million. Adults were 0.75 times less likely to identify a physician's office and 1.8 times more likely to identify an outpatient clinic as that source of care in 1992 than they were in 1987. These changes were observed among Americans of all demographic and socioeconomic backgrounds. Increasing numbers of adult Americans without a usual source of care and shifts in care from physicians' offices to outpatient clinics may reflect deteriorating access to care. This may affect quality and costs of medical care, demanding continued surveillance of sources and access to care.
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Boll A, Moore AJ, Brown JP, Kershaw JH, Flanigan BE. Ambulatory care growth: implications for academic organizations. J Ambul Care Manage 1997; 20:53-60. [PMID: 10181606 DOI: 10.1097/00004479-199704000-00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article discusses the implications of the dramatic growth of outpatient activity in academic health care organizations, and, more broadly, in all forms of joint physician-hospital outpatient care. The authors describe several economic, operational, and regulatory factors that influence the success of ambulatory care expansion in the academic environment. A case study of the Metropolitan New York Medicaid managed care environment illustrates the impact of these factors and highlights the specific challenges confronting teaching hospitals and physicians. The attributes of ambulatory care providers that have successfully addressed these challenges are also discussed. Finally, the benefits of the model ambulatory practice structure, employed at a number of teaching institutions across the country, are explored.
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Radensky P, Batavia A, Zimmerman E. A new payment system for outpatient services? The implications for radiology. RADIOLOGY MANAGEMENT 1997; 19:27-34. [PMID: 10166744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Congress is now contemplating the most significant change in outpatient payment methodology in Medicare's 31-year history. It may approve a proposal by the Health Care Financing Administration (HCFA) to establish a Medicare prospective payment system for hospital outpatient departments. In March 1955, five years after a Congressional directive to develop a new outpatient payment system, HCFA delivered its proposal recommending use of the ambulatory patient groups (APG) classification system for determining payment of hospital outpatient services. The APG system, which uses outpatient procedures as its primary variable, divides all such procedures into one of three categories: 1) significant procedures or therapies (including therapeutic and other significant radiological procedures); 2) ancillary test and procedures (including 11 radiology ancillary service APGs); or 3) medical visits. Outpatients can be assigned to one or more of the 290 APGs, each comprising a number of clinically and resource intensity-similar procedures, medical visits or ancillary tests. Any new payment methodology for outpatient procedures would broadly impact the radiology community. How radiology providers will fare under the system being proposed will depend on several issues that have not yet been resolved, such as how the basic unit of payment is defined (e.g., a service, a visit, or an episode of care) and whether payment rates will be adequate to compensate for the costs of providing services. One key issue will be whether contrast media and radiopharmaceuticals will continue to be paid as pass-through costs, giving providers the flexibility to choose the specific agent that is most appropriate for their patients.
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Gerson V, Vernarec E. Are we squeezing the life out of hospitals? THE STATE OF HEALTH CARE IN AMERICA 1996:25-9. [PMID: 10168080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
A decade of cost cutting has left many hospitals in financial disarray, yet others are thriving amid the forces of change. Their creative responses are blueprints for survival.
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Guinn RM. The outpatient hospital: a hospital without beds. WORLD HOSPITALS AND HEALTH SERVICES : THE OFFICIAL JOURNAL OF THE INTERNATIONAL HOSPITAL FEDERATION 1996; 33:33-42. [PMID: 10169452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
A radical reordering of the hospital building looms on the horizon. By the advent of the new millennium just a few years away, the outpatient hospital--a hospital without beds--will be the new healthcare model. The outpatient premise is that a wellness system is fundamentally different from a medical care system. The patient is no longer forced to distinguish between his ongoing health maintenance needs and his intermittent medical intervention needs. The barrier between the public health system and the acute care system disintegrates, and the two merge into one entity. Thus, hospitals evolve into outpatient wellness centers where the building's physical structure is a single entity in terms of service points.
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Survey: competition propels ambulatory market growth. HOSPITALS & HEALTH NETWORKS 1995; 69:12. [PMID: 7606261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
Current trends in AIDS care in the United States, including dehospitalization and improved outpatient treatment, may place many persons with AIDS (PWAs) at increased risk for having unmet need for help with daily living demands. Using interviews with 224 PWAs, we examined the prevalence and correlates of unmet need for assistance across six functional domains: personal care, instrumental activities of daily living (e.g. home chores, using transportation), social functioning, role performance, taking care of one's health and negotiating systems. Overall, 74.1% of respondents reported having either a partially or completely unmet need for help in one or more areas of functioning. Unmet need for help was highest for instrumental activities of daily living (46.4%). Unmet need was associated with illness severity (i.e. more symptoms and hospitalizations), minority status and support network characteristics (proximity, size and type of supporters). Implications of unmet needs data for improving the clinical care of PWAs are discussed.
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Zuckerman AM. Future schlock. Will willy-nilly investments in ambulatory care facilities today result in even more problems tomorrow? Two case studies provide telling insights. HEALTH FACILITIES MANAGEMENT 1995; 8:24, 26-8, 30. [PMID: 10141257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Duffy SQ, Farley DE. Patterns of decline among inpatient procedures. Public Health Rep 1995; 110:674-81. [PMID: 8570816 PMCID: PMC1381805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
This paper explores how the new financial incentives and organizational structures that prevail in the hospital industry have affected the mix of services provided by hospitals. Using data from the Agency for Health Care Policy and Research's Healthcare Cost and Utilization Project, the authors studied the 150 procedures that were most frequently performed on inpatients in 1980. They found that (a) 37 of the 150 procedures declined in use more than 40 percent by 1987, (b) patients that continued to receive one of the 37 procedures in 1987 on an inpatient basis tended to be more severely ill than in 1980, and (c) rates of decline were disproportionately large for Medicaid recipients. Three main factors have contributed to the decline in inpatient use of these procedures. Most important has been the shift from inpatient to outpatient settings, a result of new technologies and pressures from reimbursement mechanisms and utilization review policies. Some procedures have been replaced by less invasive, more effective approaches. Other procedures are now considered ineffective by the medical community and have been largely abandoned as a result.
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81
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Marberry SO. How reform is shaping up. ARCHITECTURAL RECORD 1994; 182:98-99. [PMID: 10134498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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82
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Bailey JJ, Black ME, Wilkin D. Specialist outreach clinics in general practice. BMJ (CLINICAL RESEARCH ED.) 1994; 308:1083-6. [PMID: 8173432 PMCID: PMC2539960 DOI: 10.1136/bmj.308.6936.1083] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To establish the extent and nature of specialist outreach clinics in primary care and to describe specialists' and general practitioners' views on outreach clinics. DESIGN Telephone interviews with hospital managers. Postal questionnaire surveys of specialists and general practitioners. SETTING 50 hospitals in England and Wales. SUBJECTS 50 hospital managers, all of whom responded. 96 specialists and 88 general practitioners involved in outreach clinics in general practice, of whom 69 (72%) and 46 (52%) respectively completed questionnaires. 122 additional general practitioner fundholders, of whom 72 (59%) completed questionnaires. MAIN OUTCOME MEASURES Number of specialist outreach clinics; organisation and referral mechanism; waiting times; perceived benefits and problems. RESULTS 28 of the hospitals had a total of 96 outreach clinics, and 32 fundholders identified a further 61 clinics. These clinics covered psychiatry (43), medical specialties (38), and surgical specialties (76). Patients were seen by the consultant in 96% (107) of clinics and general practitioners attended at only six clinics. 61 outreach clinics had shorter waiting times for first outpatient appointment than hospital clinics. The most commonly reported benefits for patients were ease of access and shorter waiting times. CONCLUSIONS Specialist outreach clinics cover a wide range of specialties and are popular, especially in fundholding practices. These clinics do not seem to have increased the interaction between general practitioners and specialists.
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83
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Zuckerman AM. A high-demand forecast for ambulatory care growth. HOSPITAL STRATEGY REPORT 1994; 6:8. [PMID: 10132524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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84
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Jones-Bey H. Patient care requires shift in perspective. DIAGNOSTIC IMAGING 1994; Suppl:32-3. [PMID: 10146696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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85
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86
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Osuga B, Nordberg E. Effects of new service charges on attendance at rural health facilities in Kenya. EAST AFRICAN MEDICAL JOURNAL 1993; 70:627-631. [PMID: 8187658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Kenyans have long enjoyed free outpatient health care at government facilities while paying for admission and for child delivery. In December 1989 user charges were introduced also for out-patient care at hospitals and health centres. This before-and-after study of one rural hospital, two health centres and two dispensaries in rural Kenya shows major and statistically significant early drops in outpatient attendance at the hospital (28%) and at the health centres (50 and 43%) followed by a slow increase during the following months. There was a modest, not significant, decline also at the dispensaries (14 and 7%) and in demand for services unaffected by the new fees and charges.
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87
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Burns J. Market opening up to the non-traditional. MODERN HEALTHCARE 1993; 23:96-8. [PMID: 10127627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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88
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Valagussa F. [From outpatient services to management]. GIORNALE ITALIANO DI CARDIOLOGIA 1993; 23:849-51. [PMID: 8119512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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89
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Di Pasquale G, Barbaresi F, Bianco GA, Labanti G, Pinelli G. [The current status of hospital outpatient cardiological care]. GIORNALE ITALIANO DI CARDIOLOGIA 1993; 23:823-30. [PMID: 8119508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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90
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Zanuttini D, Rellini GL. [The hospital and the organization of cardiological care: the evolution of the outpatient area]. GIORNALE ITALIANO DI CARDIOLOGIA 1993; 23:815-22. [PMID: 8119507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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91
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Data watch. Outpatient procedures. HOSPITALS & HEALTH NETWORKS 1993; 67:52. [PMID: 8319019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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92
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Albretsen CS. [Development of the psychiatric outpatient clinics in Oslo. Thoughts on history and future]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 1993; 113:985. [PMID: 8470087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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93
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Data watch. Hospitals prepare for ambulatory care growth. HOSPITALS 1993; 67:54. [PMID: 8436381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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94
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Dorris VK. Healthy trends. ARCHITECTURE (WASHINGTON, D.C.) 1993; 82:91-3. [PMID: 10124544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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95
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Zuckerman AM. Have focused strategy for ambulatory care. MODERN HEALTHCARE 1993; 23:33-4. [PMID: 10123678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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96
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Wahlqvist ML, Boyce N, Howard J, Wright C, Allen S. Change and opportunity in ambulatory care. AUST HEALTH REV 1992; 16:446-53. [PMID: 10184216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Non-inpatient care is assuming greater importance within the Australian health system. The management of the delivery of health services is becoming a responsibility of clinicians. Clinicians, nurses, managers and academics need to come together to advance these issues. This paper outlines the thinking at Monash Medical Centre, a new 747-bed tertiary hospital situated in the south-eastern suburbs of Melbourne.
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97
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Anderson HJ. Pain centers take many approaches to patient care. HOSPITALS 1992; 66:46-7. [PMID: 1639374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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98
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Henrich JB, Rahn DW, Fiebach NH. Integrating general medicine and rheumatology training in the outpatient setting: a practice model. J Gen Intern Med 1992; 7:434-6. [PMID: 1506951 DOI: 10.1007/bf02599163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The authors describe a primary care-based educational and practice model that integrates general medicine resident education in outpatient rheumatology with specialty fellowship training. Compared with the use of traditional specialty clinics, the model provides better access and service to patients and more appropriate training for residents. Revenues from clinical service delivered by faculty-supervised residents and fellows support 80% of the operating costs and educational activities of the model. The conceptual framework for the model reconciles the educational goals and practice philosophies of general medicine and specialty training and is applicable to training in other predominantly outpatient specialty areas.
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99
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Hoare J. Day surgery. HEALTH SERVICES MANAGEMENT 1992; 88:12-4. [PMID: 10171051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Costing half as much as inpatient treatment, with good results and advantages to patients, day surgery might be expected to be more widespread than it is. Purchasers may be those who push for more by specifying targets for day surgery for certain procedures. How can managers respond?
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100
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Kessler DM, Davis EB. Preparing for Medicare outpatient payment reform. HEALTH CARE STRATEGIC MANAGEMENT 1992; 10:9-11. [PMID: 10171030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Orthopedic hospitals, institutions with a high volume of surgeries, and hospitals with high Medicare populations should learn from the experiences of eye and ear hospitals, some of which could have been put out of business by Medicare outpatient payment reforms proposed in 1986 and partially implemented since then. As the reforms are refined, hospitals should analyze their vulnerability to the proposed changes using the matrix proposed in this article. They should also take steps to counter any negative impact on revenues and try to influence the nature and scope of the reforms.
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