Hospital payment effects on acute inpatient care for mental disorders

The Effect of Judgement Bias on Cue Utilization for Shot Prediction in Basketball Athletes

BACKGROUND

Concerning the judgments bias and cue utilization in basketball athletes, previous shot anticipation tasks were hard to examine in regards to whether the experts' judgement bias relies more on the cue of the player's body or the ball trajectory.

METHODS

Four types of body-ball cues shots were employed: IN-IN, IN-OUT, OUT-IN, and OUT-OUT. Four temporal stages (i.e., shooting, rising, high point, and falling) were divided during a shot. Forty-two participants predicted the fate of the ball after watching the shot videos.

RESULTS

The results suggested that for the shooting, rising, and high point phase, compared to the non-athletes, the experts provided superior predictions for IN-IN condition and OUT-IN condition but fewer accurate predictions for IN-OUT condition and OUT-OUT condition. Moreover, a higher bias toward predicting the shots as "in" for the athletes than the non-athletes under early temporal conditions was confirmed.

CONCLUSIONS

These findings strengthen the idea that the IN cues from both body information and ball trajectory could elicit the experts' judgement bias for made shots and then influence their response, thus rendered two distinct (e.g., impeding and facilitating) effects for the incongruent body-ball cues, respectively.

The effects of sport expertise and shot results on basketball players' action anticipation

The purpose of the present cross-sectional study was to clarify the effects of sport expertise and shot results on the action anticipation of basketball players. Eighty-eight male subjects participated in this study, namely, 30 collegiate basketball players, 28 recreational basketball players and 30 non-athletes. Each participant performed a shot anticipation task in which he watched the shooting phase, rising phase, high point and falling phase of a free throw and predicted the fate of the ball. The results showed that the collegiate players and recreational players demonstrated higher accuracy than the non-athletes for the falling phase but not for the other temporal conditions. Analysis of the shot results demonstrated that for made shots, the collegiate players and recreational players provided more accurate predictions than the non-athletes. These results suggested that the experienced players required a sufficient amount of information to be able to make accurate judgements and demonstrated that the experts’ judgement bias for made shots was independent of the temporal condition.

Supply factors as determinants of treatment costs: clinicians' assessments of a given set of referrals to community mental health centers in Norway

BACKGROUND

Previous works that uses patterns of prior spending to predict future mental health care expenses (utilization models) are mainly concerned with demand (need) variables. In this paper, we introduce supply variables, both individual rater variables and center variables. The aim is to assess these variables' explanatory power, and to investigate whether not accounting for such variables could create biased estimates for the effects of need variables.

METHODS

We employed an observational study design where the same set of referrals was assessed by a sample of clinicians, thus creating data with a panel structure being particularly relevant for analyzing supply factors. The referrals were obtained from Norwegian Community Mental Health Centers (outpatient services), and the clinicians assessed the referrals with respect to recommended treatment costs and health status.

RESULTS

Supply variables accounted for more than 10% of the total variation and about one third of the explained variation. Two groups of supply variables, individual rater variables and center variables (institutions) were equally important.

CONCLUSIONS

Our results confirm that supply factors are important but ignoring such variables, when analyzing demand variables, do not generally seem to produce biased (confounded) coefficients.

Associations of homelessness and residential mobility with length of stay after acute psychiatric admission

BACKGROUND

A small number of patient-level variables have replicated associations with the length of stay (LOS) of psychiatric inpatients. Although need for housing has often been identified as a cause of delayed discharge, there has been little research into the associations between LOS and homelessness and residential mobility (moving to a new home), or the magnitude of these associations compared to other exposures.

METHODS

Cross-sectional study of 4885 acute psychiatric admissions to a mental health NHS Trust serving four South London boroughs. Data were taken from a comprehensive repository of anonymised electronic patient records. Analysis was performed using log-linear regression.

RESULTS

Residential mobility was associated with a 99% increase in LOS and homelessness with a 45% increase. Schizophrenia, other psychosis, the longest recent admission, residential mobility, and some items on the Health of the Nation Outcome Scales (HoNOS), especially ADL impairment, were also associated with increased LOS. Informal admission, drug and alcohol or other non-psychotic diagnosis and a high HoNOS self-harm score reduced LOS. Including residential mobility in the regression model produced the same increase in the variance explained as including diagnosis; only legal status was a stronger predictor.

CONCLUSIONS

Homelessness and, especially, residential mobility account for a significant part of variation in LOS despite affecting a minority of psychiatric inpatients; for these people, the effect on LOS is marked. Appropriate policy responses may include attempts to avert the loss of housing in association with admission, efforts to increase housing supply and the speed at which it is made available, and reforms of payment systems to encourage this.

The effect of funding policy on day of week admissions and discharges in hospitals: the cases of Austria and Canada

This paper compares two different funding policies for inpatients, the case-based approach in Austria versus the global budgeting approach in Canada. It examines the impact of these funding policies on length of stay of inpatients as one key measure of health outcome. In our study, six major clinical categories for inpatients are selected in which the day of the week for admission is matched to the particular day of the week of discharge for each individual case. The strategic statistical analysis proves that funding policies have a significant impact on the expected length of stay of inpatients. For all six clinical categories, Austrian inpatients stayed longer in hospitals compared to Canadian inpatients. Moreover, inpatients were not admitted and discharged equally throughout the week. We also statistically prove for certain clinical categories that more inpatients are discharged on certain days such as Mondays or Fridays depending on the funding policy. Our study is unique in the literature and our conclusions indicate that, with the right incentives in place, the length of stay can be decreased and discharge anomalies can be eliminated, which ultimately leads to a decrease in healthcare expenditures and an increase in healthcare effectiveness.

Impact of an all-inclusive diagnosis-related group payment system on inpatient utilization

OBJECTIVES

Although case-based payment is one of the main reimbursement mechanisms for hospitals, little is known about its effects in the general population. Prior studies have focused on Medicare or on all-payer systems in particular states. This study estimates the effect of a prospective payment system based on diagnosis-related groups (DRGs) nationwide in the Department of Veterans Affairs.

METHODS

Multiple regression analysis was used to estimate the effect of Department of Veterans Affairs's diagnosis-related group system separately for 22 diagnoses. The dependent variables were length of stay, inpatient days per patient, and discharges per patient. Covariates included patient, hospital, and area characteristics.

RESULTS

Department of Veterans Affairs's diagnosis-related group system reduced lengths of stay and inpatient days per patient. The largest impacts were for the psychiatric diagnoses and several surgical procedures. The magnitudes of the effects were generally moderate. Department of Veterans Affairs's case-based system had a negligible effect on discharges per patient.

CONCLUSIONS

Per case reimbursement is a potentially useful tool for improving the efficiency of inpatient care for all types of diagnoses and age groups. The effect may be larger than estimated here because of institutional barriers and caps on financial impact.

DRGs: an overview of the issues

The prospective payment system based on diagnostic related groups adopted by Medicare in 1983 has many deficiencies with respect to psychiatric care. Due to the efforts of the American Psychiatric Association, psychiatric units in general hospitals have been temporarily exempted from this system of per-care payment. A number of problematic issues need to be addressed in the design of any modified or alternative system of financing psychiatric care. These issues include the problems of premature discharge, code manipulation, cost-shifting, and equitable patient access to psychiatric services. The potential effects of a DRG system of payment on clinical practice are reviewed. The reasons for the shortcomings of the DRG system in predicting utilization of services are discussed, and areas for future research are suggested.