scholarly journals Health Care Management Models for the Evolution of Hospitalization in Acute Inpatient Psychiatry Units: Comparative Quantitative Study

10.2196/15776 ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. e15776
Author(s):  
Susel Góngora Alonso ◽  
Beatriz Sainz-De-Abajo ◽  
Isabel De la Torre-Díez ◽  
Manuel Franco-Martin
Keyword(s):  
Health Care ◽  
Mental Disorders ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Hospital Management ◽  
Management Model ◽  
Inpatient Psychiatry ◽  
Mental Diseases ◽  
Hospital Days ◽  
The Impact

Background Mental health disorders are a problem that affects patients, their families, and the professionals who treat them. Hospital admissions play an important role in caring for people with these diseases due to their effect on quality of life and the high associated costs. In Spain, at the Healthcare Complex of Zamora, a new disease management model is being implemented, consisting of not admitting patients with mental diseases to the hospital. Instead, they are supervised in sheltered apartments or centers for patients with these types of disorders. Objective The main goal of this research is to evaluate the evolution of hospital days of stay of patients with mental disorders in different hospitals in a region of Spain, to analyze the impact of the new hospital management model. Methods For the development of this study, a database of patients with mental disorders was used, taking into account the acute inpatient psychiatry unit of 11 hospitals in a region of Spain. SPSS Statistics for Windows, version 23.0 (IBM Corp), was used to calculate statistical values related to hospital days of stay of patients. The data included are from the periods of 2005-2011 and 2012-2015. Results After analyzing the results, regarding the days of stay in the different health care complexes for the period between 2005 and 2015, we observed that since 2012 at the Healthcare Complex of Zamora, the total number of days of stay were reduced by 64.69%. This trend is due to the implementation of a new hospital management model in this health complex. Conclusions With the application of a new hospital management model at the Healthcare Complex of Zamora, the number of days of stay of patients with mental diseases as well as the associated hospital costs were considerably reduced.

scholarly journals Health Care Management Models for the Evolution of Hospitalization in Acute Inpatient Psychiatry Units: Comparative Quantitative Study (Preprint)

2019 ◽  
Author(s):  
Susel Góngora Alonso ◽  
Beatriz Sainz-De-Abajo ◽  
Isabel De la Torre-Díez ◽  
Manuel Franco-Martin
Keyword(s):  
Health Care ◽  
Mental Disorders ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Hospital Management ◽  
Management Model ◽  
Inpatient Psychiatry ◽  
Mental Diseases ◽  
Hospital Days ◽  
The Impact

BACKGROUND Mental health disorders are a problem that affects patients, their families, and the professionals who treat them. Hospital admissions play an important role in caring for people with these diseases due to their effect on quality of life and the high associated costs. In Spain, at the Healthcare Complex of Zamora, a new disease management model is being implemented, consisting of not admitting patients with mental diseases to the hospital. Instead, they are supervised in sheltered apartments or centers for patients with these types of disorders. OBJECTIVE The main goal of this research is to evaluate the evolution of hospital days of stay of patients with mental disorders in different hospitals in a region of Spain, to analyze the impact of the new hospital management model. METHODS For the development of this study, a database of patients with mental disorders was used, taking into account the acute inpatient psychiatry unit of 11 hospitals in a region of Spain. SPSS Statistics for Windows, version 23.0 (IBM Corp), was used to calculate statistical values related to hospital days of stay of patients. The data included are from the periods of 2005-2011 and 2012-2015. RESULTS After analyzing the results, regarding the days of stay in the different health care complexes for the period between 2005 and 2015, we observed that since 2012 at the Healthcare Complex of Zamora, the total number of days of stay were reduced by 64.69%. This trend is due to the implementation of a new hospital management model in this health complex. CONCLUSIONS With the application of a new hospital management model at the Healthcare Complex of Zamora, the number of days of stay of patients with mental diseases as well as the associated hospital costs were considerably reduced.

scholarly journals 3247 Implementing an Interdisciplinary, Student-Run Consult Service for Homeless Patients: The Critical Role of Community Partnerships

2019 ◽  
Vol 3 (s1) ◽  
pp. 91-91
Author(s):  
Frances Loretta Gill
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Community Partnerships ◽  
Care Utilization ◽  
Consult Service ◽  
Utilization Patterns ◽  
Ed Visits ◽  
Hospital Days ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: Elucidate the unique challenges associated with hospital discharge planning for patients experiencing homelessness. Assess the impact of robust community partnerships and strong referral pathways on participating patients’ health care utilization patterns in an interdisciplinary, student-run hospital consult service for patients experiencing homelessness. Identify factors (both patient-level and intervention-level) that are associated with successful warm hand-offs to outside social agencies at discharge. METHODS/STUDY POPULATION: To assess the impact of participation in HHL on patients’ health care utilization, we conducted a medical records review using the hospital’s electronic medical record system comparing patients’ health care utilization patterns during the nine months pre- and post- HHL intervention. Utilization metrics included number of ED visits and hospital admissions, number of hospital days, 30-day hospital readmissions, total hospital costs, and follow-up appointment attendance rates, as well as percentage of warm hand-offs to community-based organizations upon discharge. Additionally, we collected data regarding patient demographics, duration of homelessness, and characteristics of homelessness (primarily sheltered versus primarily unsheltered, street homeless versus couch surfing, etc) and intervention outcome data (i.e. percentage of warm hand-offs). This study was reviewed and approved by the Tulane University Institutional Review Board and the University Medical Center Research Review Committee. RESULTS/ANTICIPATED RESULTS: For the first 41 patients who have been enrolled in HHL, participation in HHL is associated with a statistically significant decrease in hospital admissions by 49.4% (p < 0.01) and hospital days by 47.7% (p < 0.01). However, the intervention is associated with a slight, although not statistically significant, increase in emergency department visits. Additionally, we have successfully accomplished warm hand-offs at discharge for 71% percent of these patients. Over the next year, many more patients will be enrolled in HHL, which will permit a more finely grained assessment to determine which aspects of the HHL intervention are most successful in facilitating warm hand-offs and decreased health care utilization amongst patients experiencing homelessness. DISCUSSION/SIGNIFICANCE OF IMPACT: Providing care to patients experiencing homelessness involves working within complex social problems that cannot be adequately addressed in a hospital setting. This is best accomplished with an interdisciplinary team that extends the care continuum beyond hospital walls. The HHL program coordinators believe that ED visits amongst HHL patients and percentage of warm hand-offs are closely related outcomes. If we are able to facilitate a higher percentage of warm hand-offs to supportive social service agencies, we may be able to decrease patient reliance on the emergency department as a source of health care, meals, and warmth. Identifying the factors associated with successful warm hand-offs upon discharge from the hospital may assist us in building on the HHL program’s initial successes to further decrease health care utilization while offering increased interdisciplinary educational opportunities for medical students.

scholarly journals Detection of mental disorders with the Patient Health Questionnaire in primary care settings in Nigeria

2010 ◽  
Vol 2 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Olawale O. Ogunsemi ◽  
Francis A. Oluwole ◽  
Festus Abasiubong ◽  
Adebayo R. Erinfolami ◽  
Olufemi E. Amoran ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Primary Care Settings ◽  
Primary Health ◽  
Patient Health ◽  
The Impact

Mental disorders lead to difficulties in social, occupational and marital relations. Failure to detect mental disorder denies patients potentially effective treatment. This study aimed to assess the prevalence and nature of mental disorders at the primary care settings and the recognition of these disorders by the attending physicians. Over a period of eight weeks, consecutive and consenting patients who attended three randomly selected primary health care facilities in Sagamu Local Government Area of Ogun state were recruited and administered a questionnaire that included a socio-demographic section and Patient Health Questionnaire (PHQ). A total of 412 subjects took part in the study. Subject age ranged from 18-90 years with a mean age of 52.50±21.08 years. One hundred and seventy-six (42.7%) of the subjects were males. A total of 120 (29.1%) of the subjects had depressive disorder, 100 (24.3%) had anxiety disorder, 196 (47.6%) somatoform disorder and 104 (25.2%) met the criteria for an alcohol related problem. The PHC physicians were only able to diagnose disorders relating to mental health in 52 (12.6%) of the subjects. Health and work situations accounted for more than three-quarters of the causes of stress experienced by the subjects. We conclude that there is a high prevalence of mental disorders among patients seen in primary care settings and that a significant proportion of them are not recognized by the primary care physicians. Stress relating to health, work and financial problems is common among primary health care attendees. Physicians in primary health care should be alert to the possibility and the impact of undetected psychiatric morbidity.

The impact of Universal Health Coverage on health care consumption and risky behaviours: evidence from Thailand

2014 ◽  
Vol 10 (3) ◽  
pp. 251-266 ◽  
Author(s):  
Simone Ghislandi ◽  
Wanwiphang Manachotphong ◽  
Viviana M.E. Perego
Keyword(s):  
Health Care ◽  
Universal Health Coverage ◽  
Hospital Admissions ◽  
Health Coverage ◽  
Positive Health ◽  
Health Care Consumption ◽  
Thai Population ◽  
Risky Behaviours ◽  
The Impact ◽  
Universal Health

AbstractThailand is among the first non-OECD countries to have introduced a form of Universal Health Coverage (UHC). This policy represents a natural experiment to evaluate the effects of public health insurance on health behaviours. In this paper, we examine the impact of Thailand’s UHC programme on preventive activities, unhealthy or risky behaviours and health care consumption using data from the Thai Health and Welfare Survey. We use doubly robust estimators that combine propensity scores and linear regressions to estimate differences-in-differences (DD) and differences-in-DD models. Our results offer important insights. First, UHC increases individuals’ likelihood of having an annual check-up, especially among women. Regarding health care consumption, we observe that UHC increases hospital admissions by over 2% and increases outpatient visits by 13%. However, there is no evidence that UHC leads to an increase in unhealthy behaviours or a reduction of preventive efforts. In other words, we find no evidence ofex antemoral hazard. Overall, these findings suggest positive health impacts among the Thai population covered by UHC.

P5003Reduced healthcare utilization in routine care initiators of empagliflozin with and without heart failure: interim analysis from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Pawar ◽  
E Patorno ◽  
A Deruaz-Luyet ◽  
K Brodovicz ◽  
A Ustyugova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Propensity Score ◽  
Comparative Effectiveness ◽  
Interim Analysis ◽  
Treatment Initiation ◽  
Hospital Admissions ◽  
Routine Care ◽  
History Of ◽  
Hospital Days ◽  
The Impact

Abstract Background Empagliflozin (EMPA) reduced the risk of hospitalization for heart failure (HHF) (HR 0.65; 95% CI 0.50- 0.85) as demonstrated in the EMPA-REG OUTCOME trial in adults with type 2 diabetes (T2D) and established CV disease. However, the impact of EMPA treatment initiation on healthcare resource utilization (HCRU) in routine care in patients with history of heart failure (HF) or without history of HF remains unexplored. Purpose To compare HCRU among EMPA and dipeptidyl peptidase-4 inhibitor (DPP4i) initiators with and without HF history at time of treatment initiation. Methods We analyzed HCRU in the first two years after marketing of EMPA as part of EMPRISE, a non-interventional study on the comparative effectiveness, safety and HCRU of EMPA for T2D patients in routine care in two US commercial and Medicare claims datasets (08/2014–09/2016). We identified a 1:1 propensity-score-matched cohort of T2D patients ≥18 years initiating either EMPA or a DPP4i with and without baseline HF, and assessed the balance at baseline (period of 365 days) on ≥140 covariates including clinical, HCRU, and cost-related covariates using absolute standardized differences. We compared the risk of first all-cause hospitalization, risk of first HHF, risk of first emergency department (ED) visit, hospital length of stay (LOS), HF-related LOS, number of hospital admissions, HF-related hospital admissions, office visits, and ED visits in EMPA and DDP4i initiators. Results After propensity score matching, we identified 2,050 pairs with HF and 15,428 pairs without HF in the three datasets with mean follow-up of 5.2 and 5.4 months, respectively. All baseline characteristics were well balanced (with aSD<0.1). Compared to patients without HF history, patients with HF were older (65 vs 58), more commonly female (51% vs 46%), and had CV history (64% vs 19%) (Table 1). Compared to DPP4i, the hazard ratio (HR) for first hospitalization was 0.68 (95% CI: 0.56, 0.83) for EMPA initiators with HF, and 0.89 (95% CI: 0.80, 1.00) for initiators without HF. Risk of HF-related hospitalization and ED visit was lower in EMPA initiators with prior HF [HR=0.53 (0.38, 0.74) and HR=0.73 (0.58, 0.93), respectively] and without prior HF [HR=0.45 (0.27, 0.73) and HR=0.82 (0.70, 0.95), respectively]. Compared to DPP4i initiators, EMPA initiators with and without baseline HF had lower number of all hospital admissions [Incidence rate ratio (IRR)= 0.59 (0.50, 0.70) and IRR= 0.78 (0.71, 0.85), respectively] and HF-related hospital admissions [IRR=0.49 (0.37, 0.65) and IRR=0.34 (0.22, 0.53), respectively]. In-hospital days and HF-related in-hospital days per member per year (PMPY) in patients with and without HF history initiating EMPA were lower than DDP4i (Table 1). Conclusions Results observed in this interim analysis of EMPRISE showed reduction in overall HCRU as well as HF-related HCRU in both patients with and without heart failure (HF) initiating EMPA compared to DDP4i initiators. Acknowledgement/Funding This study was supported by a research grant to the Brigham and Women's Hospital from Boehringer-Ingelheim.

scholarly journals Health coach online - health benefits on the citizens terms

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Kuitunen ◽  
A Cavrak
Keyword(s):  
Health Care ◽  
Healthy Lifestyle ◽  
Eating Habits ◽  
Hospital Costs ◽  
Diabetes Type 2 ◽  
Cost Effective ◽  
Health Coaching ◽  
Unhealthy Lifestyle ◽  
Lifestyle Habits ◽  
The Impact

Abstract In Sweden, we know that half of the women and two thirds of the men have one or more unhealthy lifestyle habits. We also know that 90% of all diabetes type 2, 80% of all heart attacks and 30% of all cancer can be prevented, if one has a healthy lifestyle. Consultative conversations have been proved very helpful while changing ones habits. The lifestyle habits of Swedes are similar to those of other countries in Europe, and by making our research available and the concept known to other countries, the overall health in Europe can improve. In August 2017 an online practice opened in a county in south west of Sweden, were we performed lifestyle interventions with people who applied and needed it. The practice specialized in eating habits, physical exercise, alcohol and tobacco use. We have 4-6 consultative meetings during 3 to 4 months, where we help our clients set realistic goals to reach, that work in their day to day life. While using coaching techniques and motivational interviewing, we have met over 200 people, and helped improve their lifestyle. We have seen that in regarding to self-assessed health (1-10), our clients score is higher after both completed health coaching and a year after completed coaching than at start. Calculating QALY, we can see that the impact the coach makes on our clients is cost effective and one person being coached saves the amount in hospital costs that we can use to coach 30 more. We have learned that online meetings are more cost effective and practical for this type of concept. Our clients feel more relaxed and open to the process at a location of their choosing and it saves time for them, time they might not have taken otherwise - therefore, we can help more people. Meetings online enables us to reach all over the Västra Götaland region, and not only the close proximity where the coaches are located. Key messages Online health coaching supports our health care and helps the citizens to improve their lifestyle habits and their overall health. The online method is cost effective and it saves money for both health care and society.

scholarly journals A closer look at the epidemiology of schizophrenia and common mental disorders in Brazil

2020 ◽  
Vol 14 (3) ◽  
pp. 283-289
Author(s):  
Randhall Bruce Carteri ◽  
Jean Pierre Oses ◽  
Taiane de Azevedo Cardoso ◽  
Fernanda Pedrotti Moreira ◽  
Karen Jansen ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Health System ◽  
Hospital Admissions ◽  
Common Mental Disorders ◽  
Age Groups ◽  
Epidemiologic Studies ◽  
Emerging Countries ◽  
Unified Health System ◽  
Hospital Expenses ◽  
The Impact

ABSTRACT. Schizophrenia and common mental disorders are noteworthy social and economic concern worldwide. Epidemiologic studies on the impact of specific mental disorders in emerging countries are scarce. Objectives: We aimed to characterize the demographic, social, and economic burden of schizophrenia and common mental disorders patients in the health system in Brazil. Methods: Data on these conditions in Brazil between 2008 and 2019 were collected through the website of the Departamento de Informática do Sistema Único de Saúde (Information Technology Department of the Unified Health System - DATASUS) maintained by the Brazilian Ministry of Health. Mean annual hospital admissions were 154,009.67, and cumulative incidence of 77.44 admissions per 100,000 inhabitants. Results: Average annual hospital expenses were US$ 67,216,056.04, with an average admission cost of US$ 432.58. The most affected age groups were older adults albeit younger individuals showed a trend towards increase of occurrences in recent years. There were a higher number of admissions in men compared to women. Conclusions: We consider the results obtained important to assist in evaluating and guiding public policies regarding the prevention and treatment in health systems.

scholarly journals Impact of economic crises on mental health care: a systematic review

2018 ◽  
Vol 29 ◽  
Author(s):  
M. Silva ◽  
D. M. Resurrección ◽  
A. Antunes ◽  
D. Frasquilho ◽  
G. Cardoso
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Health Care ◽  
Mental Health Care ◽  
Economic Crisis ◽  
Mental Health Problems ◽  
Hospital Admissions ◽  
Health Problems ◽  
Economic Crises ◽  
The Impact

Abstract Aims Unmet needs for mental health treatment are large and widespread, and periods of economic crisis may increase the need for care and the treatment gap, with serious consequences for individuals and society. The aim of this systematic review was to summarise the empirical evidence on the association between periods of economic crisis and the use of mental health care. Methods Following the PRISMA statement, MEDLINE, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications, published between 1990 and 2018, from inception to June 2018. Search terms included (1) economic crisis, (2) use of mental health services and (3) mental health problems. Study selection, data extraction and the assessment of study quality were performed in duplicate. Results Seventeen studies from different countries met the inclusion criteria. The results from the included articles suggest that periods of economic crisis might be linked to an increase of general help sought for mental health problems, with conflicting results regarding the changes in the use of specialised psychiatric care. The evidence on the use of mental health care specifically due to suicide behaviour is mixed. The results also suggest that economic crises might be associated with a higher use of prescription drugs and an increase in hospital admissions for mental disorders. Conclusions Research on the impact of economic crises on the use of mental health care is scarce, and methodologies of the included papers are prone to substantial bias. More empirical and long-term studies on this topic are needed, in order to adapt mental health care systems to the specific needs of the population in times of economic crisis.

Drug-Related Visits to the Emergency Department

2005 ◽  
Vol 18 (5) ◽  
pp. 329-335 ◽  
Author(s):  
Peter J. Zed
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Hospital Admissions ◽  
Medical Attention ◽  
Limited Information ◽  
Current Health ◽  
The Past ◽  
Ed Visits ◽  
Current Health Care System ◽  
The Impact

Over the past few years, several published reports have addressed the problem of drug-related morbidity in various practice settings. Studies evaluating drug-related hospitalization have estimated that approximately 5% to 10% of all hospital admissions are drug related. Unfortunately, many of these studies have excluded patients seeking medical attention in the emergency department (ED) but not requiring hospital admission. Drug-related visits to the emergency department are a significant problem and contribute to overall pressures on our current health care system. Despite the limited information published regarding drug-related ED visits, several studies describe the impact of this issue. The purpose of this article is to review the current literature pertaining to the incidence, classification, severity, preventability, and economic impact of drug-related visits to the emergency department.

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