The specialty-variation effect on the utilization of outpatient service at the COVID-contained hospitals in Taiwan.
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ABSTRACT:
SUBMITTER: Chen JY
PROVIDER: S-EPMC8099732 | biostudies-literature | 2021 May
REPOSITORIES: biostudies-literature
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The specialty-variation effect on the utilization of outpatient service at the COVID-contained hospitals in Taiwan.
Chen Jia-Yu JY Liu Yu-Chuan YC Lee Po-Chang PC Lien Wan-Ching WC
Journal of the Formosan Medical Association = Taiwan yi zhi 20210506 10
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Project description:ObjectiveTo compare the costs of physician-owned cardiac, orthopedic, and surgical single specialty hospitals with those of full-service hospital competitors.Data sourcesThe primary data sources are the Medicare Cost Reports for 1998-2004 and hospital inpatient discharge data for three of the states where single specialty hospitals are most prevalent, Texas, California, and Arizona. The latter were obtained from the Texas Department of State Health Services, the California Office of Statewide Health Planning and Development, and the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. Additional data comes from the American Hospital Association Annual Survey Database.Study designWe identified all physician-owned cardiac, orthopedic, and surgical specialty hospitals in these three states as well as all full-service acute care hospitals serving the same market areas, defined using Dartmouth Hospital Referral Regions. We estimated a hospital cost function using stochastic frontier regression analysis, and generated hospital specific inefficiency measures. Application of t-tests of significance compared the inefficiency measures of specialty hospitals with those of full-service hospitals to make general comparisons between these classes of hospitals.Principal findingsResults do not provide evidence that specialty hospitals are more efficient than the full-service hospitals with whom they compete. In particular, orthopedic and surgical specialty hospitals appear to have significantly higher levels of cost inefficiency. Cardiac hospitals, however, do not appear to be different from competitors in this respect.ConclusionsPolicymakers should not embrace the assumption that physician-owned specialty hospitals produce patient care more efficiently than their full-service hospital competitors.
| S-EPMC2654166 | biostudies-literature
Project description:BackgroundMultiple payment reform efforts are under way to improve the value of care delivered to Medicare beneficiaries, yet few directly address the interface between primary and specialty care.ObjectiveTo describe regional variation in outpatient visits for individual specialties and the association between specialty physician-specific payments and patient-reported satisfaction with care and health status.DesignRetrospective cross-sectional study.PatientsA 20 % random sample of Medicare fee-for-service beneficiaries in 2012.Main measuresRegions were grouped into quartiles of specialist index, defined as the observed/expected regional likelihood of having an outpatient visit to a specialist, for ten common specialties, adjusting for age, sex, and race. Outcomes were per capita specialty-specific physician payments and Medicare Current Beneficiary Survey responses.Key resultsThe proportion of beneficiaries seeing a specialist varied the most for endocrinology and gastroenterology (3.7- and 3.9-fold difference between the highest and lowest quartiles, respectively) and least for orthopedics and urology (1.5- and 1.7-fold difference, respectively). Multiple analyses suggested that this variation was not explained by prevalence of disease. Average specialty-specific payments were strongly associated with the likelihood of visiting a specialist. Differences in per capita payments from lowest (Q1) to highest quartiles (Q4) were greatest for cardiology ($89, $135, $172, $251) and dermatology ($46, $64, $82, $124). Satisfaction with overall care (median [interquartile range] across specialties: Q1, 93.3 % [92.6-93.7 %]; Q4, 93.1 % [92.9-93.2 %]) and self-reported health status (Q1, 37.1 % [36.9-37.7 %]; Q4, 38.2 % [37.2-38.4 %]) was similar across quartiles. Satisfaction with access to specialty care was consistently lower in the lowest quartile of specialty index (Q1, 89.7 % [89.2-91.1 %]; Q4, 94.5 % [94.4-94.8 %]).ConclusionsSubstantial regional variability in outpatient specialist visits is associated with greater payments with limited benefits in terms of patient-reported satisfaction with care or reported health status. Reducing outpatient physician visits may represent an important opportunity to improve the efficiency of care.
| S-EPMC5071277 | biostudies-literature
Project description:ObjectivesThe COVID-19 pandemic created challenges accessing mental health (MH) services when adolescent well-being declined. Still, little is known on how the COVID-19 pandemic affected outpatient MH service utilization for adolescents.MethodsRetrospective data was collected from electronic medical records of adolescents aged 12 to 17 years at Kaiser Permanente Mid-Atlantic States, an integrated healthcare system from January 2019 to December 2021. MH diagnoses included anxiety, mood disorder/depression, anxiety and mood disorder/depression, attention deficit/hyperactivity disorder, or psychosis. We used interrupted time series analysis to compare MH visits and psychopharmaceutical prescribing before and after the COVID-19 onset. Analyses were stratified by demographics and visit modality.ResultsThe study population of 8,121 adolescents with MH visits resulted in a total 61,971 (28.1%) of the 220,271 outpatient visits associated with a MH diagnosis. During 15,771 (7.2%) adolescent outpatient visits psychotropic medications were prescribed. The increasing rate of MH visits prior to COVID-19 was unaffected by COVID-19 onset; however, in-person visits declined by 230.5 visits per week (p < 0.001) from 274.5 visits per week coupled with a rise in virtual modalities. Rates of MH visits during the COVID-19 pandemic differed by sex, mental health diagnosis, and racial/ethnic identity. Psychopharmaceutical prescribing during MH visits declined beyond expected values by a mean of 32.8 visits per week (p < 0.001) at the start of the COVID-19 pandemic.ConclusionsA sustained switch to virtual visits highlight a new paradigm in care modalities for adolescents. Psychopharmaceutical prescribing declined requiring further qualitative assessments to improve the quality of access for adolescent MH.
| S-EPMC10250250 | biostudies-literature
Project description:ObjectivePsychiatric hospitalizations and emergency department (ED) visits occur more frequently for youths with autism spectrum disorder (ASD). One mechanism that may reduce the likelihood of these events is utilization of home and community-based care. Using commercial claims data and a rigorous analytical framework, this retrospective study examined whether spending on outpatient services for ASD, including occupational, physical, and speech therapies and other behavioral interventions, reduced the likelihood of psychiatric hospitalizations and ED visits.MethodsThe study sample was composed of >100,000 children and young adults with ASD and commercial insurance from every state between 2008 and 2012. The authors estimated maximum-likelihood complementary log-log link survival models with robust standard errors. The outcomes of interest were a hospitalization or an ED visit with an associated psychiatric diagnosis code (ICD-9-CM 290 through 319) in a given week.ResultsAn increase of $125 in weekly spending on ASD-specific outpatient services in the 7 to 14 weeks prior to a given week reduced the likelihood of a psychiatric hospitalization in that week by 2%. ASD-specific outpatient spending during the 6 weeks prior to a psychiatric hospitalization did not decrease risk of hospitalization. Spending on ASD-specific outpatient services did not reduce the likelihood of a psychiatric ED visit.ConclusionsThe financial burden associated with ASD is extensive, and psychiatric hospitalizations remain the most expensive type of care, costing more than $4,000 per week on average. Identifying the mechanisms by which psychiatric hospitalizations occur may reduce the likelihood of these events.
| S-EPMC6773491 | biostudies-literature
Project description:Background:The Indian Health Service (IHS) has an agreement with the US Department of Veterans Affairs (VA) that allows IHS to use the VA Consolidated Mail Outpatient Pharmacy (CMOP) to send prescriptions to IHS patients. However, there is high variability among IHS facilities in the use of CMOP. Furthermore, there is no available resource that summarizes the relative positives/negatives, challenges/opportunities, and strengths/weaknesses of implementing CMOP. Methods:A 10-item questionnaire was developed to collect information on various aspects of prescription processing through CMOP. The questionnaire was distributed among the primary CMOP contacts of IHS facilities between December 2018 and January 2019. Results:The CMOP contacts at 44 of 94 (47%) IHS sites responded to the survey. Of the 347 respondents, 310 (89%) pharmacists were trained in CMOP prescription processing. To get information about CMOP rejections, 53% (185/347) of pharmacists check electronic messages. Twelve (27%) sites utilize technicians in some capacity in the CMOP process. Of the 16 facilities that require patients to request prescriptions to be mailed for each refill request, 8 (50%) do not use any method to designate a CMOP patient. Three sites (7%) have measured patient satisfaction with the CMOP program. Thirteen sites (31%) reported that they are losing insurance reimbursements by using CMOP. The decrease in insurance reimbursements, lengthy prescription processing time, and medication backorders are the most common challenges shared by respondents. Conclusions:CMOP presents unique challenges to pharmacy workflow but provides many benefits that local pharmacy mailout programs usually do not possess, such as the ability to mail refrigerated items. Furthermore, it is likely that local programs that utilize mail delivery will increase pharmacy workload. However, there is a lack of objective data to assess the net effect of CMOP on patients. Nevertheless, the successful implementation of CMOP can lead to reduced pharmacy workload while increasing access to care for patients with transportation issues.
| S-EPMC7473714 | biostudies-literature
Project description:BackgroundThe COVID-19 pandemic has had profound effects on healthcare systems worldwide, not only by straining medical resources but also by significantly impacting hospital revenues. These economic repercussions have varied across different hospital departments and facility sizes. This study posits that outpatient (OPD) revenues experienced greater reductions than inpatient (IPD) revenues and that the financial impact was more profound in larger hospitals than in smaller hospitals.MethodsWe collected data on patient case numbers and associated revenues for 468 hospitals from the Taiwan government-run National Health Insurance Administration website. We then employed Microsoft Excel to construct scatter plots using the trigonometric function (=DEGREES (Atan (growth rate))) for each hospital. Our analysis scrutinized 4 areas: the case numbers and the revenues (represented by medical fees) submitted to the Taiwan government-run National Health Insurance Administration in both March and April of 2019 and 2020 for OPD and IPD departments. The validity of our hypotheses was established through correlation coefficients (CCs) and chi-square tests. Moreover, to visualize and substantiate the hypothesis under study, we utilized the Kano diagram. A higher CC indicates consistent counts and revenues between 2019 and 2020.ResultsOur findings indicated a higher impact on OPDs, with CCs of 0.79 and 0.83, than on IPDs, which had CCs of 0.40 and 0.18. Across all hospital types, there was a consistent impact on OPDs (P = .14 and 0.46). However, a significant variance was observed in the impact on IPDs (P < .001), demonstrating that larger hospitals faced greater revenue losses than smaller facilities, especially in their inpatient departments.ConclusionThe two hypotheses confirmed that the COVID-19 pandemic impacted outpatient departments more than inpatient departments. Larger hospitals in Taiwan faced greater financial challenges, especially in inpatient sectors, underscoring the pandemic's varied economic effects. The COVID-19 pandemic disproportionately affected outpatient departments and larger hospitals in Taiwan. Policymakers must prioritize support for these areas to ensure healthcare resilience in future epidemics. The research approach used in this study can be utilized as a model for similar research in other countries affected by COVID-19.
| S-EPMC10637565 | biostudies-literature
Project description:IntroductionAlthough eating disorders (EDs) affect youth from all socioeconomic backgrounds, little is known about the treatment experiences of under-resourced youth with EDs. To address this gap, we examined patterns of outpatient and inpatient service utilization among publicly-insured youth with EDs in California and potential disparities for youth with additional marginalized identities.MethodParticipants were identified from the full sample of California Medicaid/Medi-Cal beneficiaries aged 7-18 with ≥ 1 service episode between January 1, 2014 and December 31, 2016. Claims data were extracted for youth with a full year of claims after the first known ED diagnosis (N = 3311) to analyze outpatient mental health, outpatient medical/physical, inpatient mental health, and inpatient medical/physical service use across ED diagnosis and demographic characteristics (sex, age, race/ethnicity, and preferred language).ResultsOutpatient individual and family therapy service utilization was low across ED diagnoses (4-7 individual therapy sessions and ≈5 family therapy sessions annually). Conversely, hospitalization rates were high, particularly among youth with anorexia nervosa (27.8%) and bulimia nervosa (30.0%). Youth with other specified feeding or ED had high medical service utilization, with more days of outpatient medical care and greater odds of medical hospitalization than youth with all other diagnoses. Latinx youth, Black youth, and boys tended to receive fewer services after accounting for diagnosis, with disparities particularly pronounced for Latinx youth.ConclusionsPublicly-insured youth with EDs in California experience high hospitalization rates but receive limited outpatient therapy. Additional research is needed to identify possible unmet needs and factors contributing to treatment disparities among these youth.
| S-EPMC11784826 | biostudies-literature
Project description:In China, most ambulatory care is provided by public hospitals. However, many public hospitals' outpatient services fall short of meeting patients' demands. This study aimed to assess the quality gap of outpatient service in public hospitals by using an indicator system developed based on the SERVQUAL model. This cross-sectional study was conducted from June to July 2019 at 13 public hospitals in Shenzhen. In total, 1876 outpatients were included in the study, and participants were asked to fill out the modified SERVQUAL questionnaire. The scale consists of 23 items scattered in 6 dimensions, including Safety, Reliability, Responsiveness, Tangibles, Assurance, and Empathy. Descriptive analysis, t-test or F-test, and optimal scale analysis were performed. The patients' expectation of outpatient services exceeded the hospitals' services they perceived and resulted in negative gaps between the mean expectation and perception scores for each indicator. The gaps were as follows: Reliability = Empathy > Responsiveness > Safety > Assurance > Tangibles. Quality gaps differed significantly between age, education, and hospital type. The overall impression mean scores are 7.45 ± 1.18 (out of 9 points) and 7.27 ± 1.23 for general and specialized hospitals. And the willingness to recommend the hospital to others mean scores are 4.06 ± 0.62 (out of 5 points) and 3.92 ± 0.65 for general and specialized hospitals. Patients' impression of the hospital and willingness to recommend the hospital were significantly correlated with age, citizenship, health insurance, referral type, frequency of visits, Safety, Tangibles, Reliability, and Assurance. The outpatient service provided by Shenzhen's public hospitals did not meet patients' needs. Hospital administrators should evaluate the quality gap of outpatient services to identify the flaws within the delivery of ambulatory care and make improvements according to the findings to drive patient-centered care.
| S-EPMC10084541 | biostudies-literature
Project description:BackgroundThe present review focuses on identifying factors contributing to health service utilization (HSU) among the general adult population according to Anderson's behavioral model.MethodsPublished articles in English on factors related to HSU were identified by systematically probing the Web of Science, MEDLINE (via PubMed research engine), and Scopus databases between January 2008 and July 2018, in accordance with the PRISMA guidelines. The search terms related to HSU were combined with terms for determinants by Boolean operators AND and OR. The database search yielded 2530 papers. Furthermore, we could find 13 additional studies following a manual search we carried out on the relevant reference lists.ResultsThirty-seven eligible studies were included in this review, and the determinants of HSU were categorized as predisposing, enabling, and need factors according to Andersen's model of HSU. The results demonstrated that all predisposing, enabling, and need factors influence HSU. In most studies, the female gender, being married, older age, and being unemployed were positively correlated with increased HSU. However, evidence was found regarding the associations between education levels, regions of residence, and HSU. Several studies reported that a higher education level was related to HSU. Higher incomes and being insured, also, significantly increased the likelihood of HSU.ConclusionThis review has identified the importance of predisposing, enabling, and need factors, which influence outpatient HSU. The prediction of prospective demands is a major component of planning in health services since, through this measure, we make sure that the existing resources are provided in the most efficient and effective way.
| S-EPMC7707632 | biostudies-literature
Project description:IntroductionReduction of maternal and neonatal morbidity and mortality has continued to be a challenge in developing countries. The majority of maternal and neonatal mortality occurred during the early postpartum period. This is mostly due to low postnatal care service utilization. There is a discrepancy of evidence on the effect status of antenatal care on the improvement of postnatal care service utilization. Therefore, this review study is aimed at estimating the pooled effect of antenatal care on postnatal care service utilization.MethodsWe searched from PubMed and Cochrane library database, Google Scholar, and Google. Initially, we found 265 articles; after duplication was removed and screened by the relevance of the titles and abstracts, 36 studies were considered for assessment of eligibility. Finally, 14 articles passed the inclusion and exclusion criteria and are included in the meta-analysis. Study quality assessment was done using Janna Briggs Institute (JBI) critical appraisal tools. The main information was extracted from each study. Heterogeneity of studies was assessed using I 2 = 70% and more considered having high heterogeneity. The publication bias was checked using funnel plot and big test. Meta-analysis using a random effect model was conducted. A forest plot was used to show the estimated size effect of odds ratio with a 95% confidence interval.ResultsA total of 14 articles were included with 15,765 participants for synthesis and meta-analysis. We found that a pooled estimate of women who had antenatal care was 1.53 times more likely to have postnatal care compared with those who had no antenatal care (AOR = 1.53, 95% CI 1.38-1.70, I 2 = 0%).ConclusionsThis review results revealed a low utilization of postnatal care service. Antenatal care service utilization has a positive effect on postnatal care service utilization. Policymakers and programmers better considered more antenatal care service use as one strategy of enhancing the utilization of postnatal care service.
| S-EPMC7528140 | biostudies-literature