Ethnic and class factors affecting mental health clinic service

Predictors of homeless veterans' irregular discharge status from a domiciliary care program

This study addresses the relationship of homeless veterans' discharge status from a domiciliary care program to biopsychosocial characteristics presented at admission into the program. Hypotheses were that younger age, less education, and substance abuse or psychiatric disorder would predict an irregular discharge. Research participants were 367 homeless male veterans who had been admitted to a domiciliary care program at the West Los Angeles Veterans Affairs Medical Center for treatment of medical, psychiatric, or substance disorders. Status of veterans' program discharge (regular or irregular) served as the outcome measure. Logistic regression analysis revealed that irregular discharge from the program was more likely among veterans who were black, who had poor employment histories, or who had problems with alcohol. Results are discussed in light of the need to maintain homeless veterans in treatment programs so that they can achieve maximum benefit from available programs.

The use of zip coded population data in social area studies of service utilization

Social area analysis (SAA) is a well-established methodology for geographically based analysis of service delivery and other health related outcome measures. However, SAA has been limited in application by the complexities of computerized geocoding and difficulties in obtaining appropriate measures of community characteristics. In this paper we demonstrate that these problems can be overcome by employing zip code as well as the unit of analysis for SAA and obtaining commercially available measures of community characteristics. Regression analyses, using New York City zip code populations as the unit of observation were used to illustrate the role of epidemiologic risk factors in predicting rates of inpatient discharge and ambulatory care visits.

Alternatives to DRGs: research issues

Legislative mandates for the development of prospective payment methodologies for reimbursing inpatient care have spurred the psychiatric community into its own independent effort, applying both clinical and service research, to develop schemes which are fair to psychiatric patients, their providers and payers. Many of the issues involved in the development of an equitable prospective payment system (PPS) for psychiatric care are not new to the field, namely, problems of limited diagnostic accuracy, a limited knowledge of the outcomes of clearly defined treatment protocols, and a lack of integration, efficiency and efficacy in a highly differentiated service system. The research community needs to respond to these problems in the context of cost containment with an awareness that its response will influence care for psychiatric patients for the remainder of this century. In this paper, we will describe the background issues that have brought the psychiatric community to the present point in its response to PPS, and discuss some of the research problems posed by the need for a PPS with the right incentives for clinical effectiveness and efficiency.

Service utilization by black and white clientele in an urban community mental health center: revised assessment of an old problem

Results of a four-year evaluation project by Harborview Community Mental Health Center to assess equity of service to its black constituency are reported. Demographic, service, and psychometric data were gathered on black and white groups which were compared with each other. It was anticipated that service delivery would be proportionate to the social and psychiatric functioning of patients regardless of race or sex. The expectation was partially confirmed. Black patients were found to be somewhat less impaired than whites, yet were referred to treatment modalities and units with apparent equity. Patterns of service at one year were significantly different, reflecting earlier termination for blacks than for whites. This finding is discussed in the context of equal socio-economic class and diagnostic grouping between ethnic groups, but differing indexes of impairment.