Benefits Of Health Services Research Articles

P-128 Myelodysplastic syndrome in Chile: Risk stratification and overall survival according to IPSS-R

There is a limited understanding of preferences for micro health insurance (MHI) as a strategy for moving towards universal health coverage. Using a discrete choice experiment (DCE), we explored community preferences for the attributes and attribute-levels of a prospective MHI scheme, aimed at filling health coverage gaps in Malawi. Through a qualitative study informed by a literature review, we identified six MHI attributes (and attribute-levels): unit of enrollment, management structure, health service benefit package, copayment levels, transportation coverage, and monthly premium per person. Qualitative data was collected from 12 focus group discussions and 8 interviews in August–September, 2012. We constructed a D-efficient design of eighteen choice-sets, each comprising two MHI choice alternatives and an opt-out. Using pictorial images, trained interviewers administered the DCE in March–May, 2013, to 814 household heads and/or their spouse(s) in two rural districts. We estimated preferences for attribute-levels and relative importance of attributes using conditional and nested logit models. The results showed that all attribute-levels except management by external NGO significantly influenced respondents' choice behavior (P < 0.05). These included: enrollment as core nuclear family (odds ratio (OR) = 1.1574), extended family (OR = 1.1132), compared to individual; management by community committee (OR = 0.9494) compared to local micro finance institution; comprehensive health service package (OR = 1.4621), medium service package (OR = 1.2761), compared to basic service package; no copayment (OR = 1.1347), 25% copayment (OR = 1.1090), compared to 50% copayment; coverage of all transport (OR = 1.5841), referral and emergency transport (OR = 1.2610), compared to no transport; and premium (OR = 0.9994). The relative importance of attributes is ordered as: transport, health services benefits, enrollment unit, premium, copayment, and management. To maximize consumer utility and encourage community acceptance of MHI, potential MHI schemes should cover transport costs, offer a comprehensive benefit package, define the core family as the unit of enrollment, avoid high copayments, and be managed by a competent financial institution.

Public health information needs in districts

Public health information needs in districts

Treatment Use and Costs Among Privately Insured Youths With Diagnoses of Bipolar Disorder

Recent evidence suggests that children are increasingly diagnosed as having bipolar disorder, yet no studies have quantified treatment costs for pediatric patients. The objectives of the study were to identify one-year health services utilization and treatment costs among youths newly diagnosed as having bipolar disorder. MarketScan administrative claims from 2005 to 2007 were used to construct a retrospective person-level cohort of children ages zero to 17 to identify one-year health services utilization and costs among privately insured youths with a bipolar diagnosis. Inpatient and outpatient services were categorized as mental health related or non–mental health related. Pharmacy costs were classified as psychotropic or nonpsychotropic. In the sample (4,973 youths), one-year mean reimbursements for health services were $10,372, and patient out-of-pocket spending was $1,429 per child. Mental health services accounted for 71% of all health care spending, with psychotropic medications and inpatient care contributing the largest proportions of total spending (24% and 27%, respectively) . The costs of care among privately insured children with bipolar disorder are similar to those of adults. However, spending on children is concentrated on mental health–related services. Because private insurance plans have historically limited mental health service benefits, the concentration of spending on mental health services may place a greater burden on families for out-of-pocket payments. As mental health parity is adopted by private insurers, monitoring its impact on patient utilization and costs of health services will be important, particularly for children with serious mental illness.

A multimodal, interdisciplinary programme for the management of cachexia and fatigue

Fatigue and cachexia are common symptoms of advanced disease that have a significant impact on quality of life for palliative care clients. Management of cachexia and fatigue is often overlooked, but growing understanding of the multidimensional nature of fatigue and muscle wasting has led to interest in a model of care based on multimodal therapy that has been successfully implemented in specialized multidisciplinary hospital-based clinics in the oncology/palliative care setting. This article reports on an innovative incorporation of features of this model into a client-centred, interdisciplinary programme that aims to manage the effects of cachexia and fatigue and to improve quality of life for palliative care clients in their home setting. This Cachexia and Fatigue Management Programme (CFMP) involves the use of an anti-inflammatory agent, high protein intake, and an individually tailored resistance exercise regimen to counteract muscle wasting and fatigue. The article provides an overview of the role of multimodal therapies in the management of cachexia and fatigue before moving on to discuss the development of the CFMP, its features, and potential benefits for palliative care clients, caregivers, and health services.

Measuring the Uptake and Impact of Chlamydia Screening Programs—Easier Said Than Done

The passage of the landmark United States (U.S.) Patient Protection and Affordable Care Act (ACA) of 2010 has placed a new emphasis on prevention services, including increased access, coverage, and improved quality of care. In this legislation, chlamydia screening qualifies along with other preventive services (The Patient Protection and Affordable Care Act, P.H. 111-148, March 2010, §2,713) as an essential health service benefit by virtue of having an "A" rating ("strongly recommended") from the U.S. Preventive Services Task Force. However, along with this important commitment of public health resources comes accountability by demonstrating outcomes and results. It should not come as a surprise that in the current era of unprecedented government budget reductions, there is a compelling need for evidence-based prioritization and impact assessment. Funding agencies increasingly need health program data to show the impact of investment in preventive services, and chlamydia screening is no exception. However, measuring the population-level impact of chlamydia screening expansion in the U.S. since the 1980s has been problematic; conflicting data on screening uptake, chlamydia burden, and adverse reproductive outcomes, including pelvic inflammatory disease (PID) and tubal factor infertility, have all been challenging to interpret, despite compelling epidemiologic evidence supporting intervention.

A multi‐method evaluation of a training course on dual diagnosis

A training course on dual diagnosis was developed within the Irish forensic mental health service, to bridge the gap in the lack of training on dual diagnosis in Ireland. The course was designed for service providers within mental health and addiction services. Twenty participants involving nursing, social work, police and social welfare disciplines attended the first training course. A mixed methodology research design was adapted to describe participants' evaluation of the training course. Data were collected using multiple methods: pre- and post-test, daily evaluation and focus group interviews. Quantitative data were analysed using the spss Version 16.0 and qualitative data were analysed thematically. Findings from the pre- and post-test suggest an increase in participants' knowledge of dual diagnosis and an increase in confidence in conducting groups. Daily evaluation indicates that the course content largely met participants' needs. Finally, three themes emerged from the focus group interview: increased confidence, the training course/teaching methods and personal/organizational challenges. This study implies that service providers within mental health and addiction services benefit from inter-professional, needs and skills based courses incorporating a variety of teaching methods. The way forward for future dual diagnosis training course developments would be working in partnership with service users and carers.

Changes in parental depression symptoms during family preservation services

Objectives Parental depression symptoms often change over the course of child welfare family preservation and parenting services. This raises the question of whether certain processes in family preservation services might be associated with depression symptom change. This study tests three correlational models of change among family preservation service participants: (a) changes in depression symptoms are one facet of broad general changes in wellbeing; (b) the quality of the home visitor-client relationship is associated depression symptom changes; and (c) linking parents to adjunctive services is associated with symptom changes. Methods Participants were 2,175 parents in family preservation services, largely for child neglect, who were surveyed using standard measures at pre-treatment, post-treatment and 6 month follow-up. Change patterns were evaluated using growth models, including bivariate parallel and multivariate second-order models. Results Parallel growth was noted among depression symptoms and changes in social, economic, familial, and parenting domains. A second order change model positing a global change pattern fit the data well. Working alliance had a modest association with improvement, but successful linkage to outside mental health services was not associated with improvement. Conclusions Changes in diverse indicators of wellbeing follow a global pattern which might support use of less complex rather than more fully comprehensive service plans. Findings about lack of adjunctive usual care mental health service benefit may be related to uncontrolled factors and this is a topic in need of additional study.

P02-158 - Trust and psychosis services: Bridging the gap between managing risk and meeting need

IntroductionResearch suggests that trust is vital for quality healthcare and effective outcomes. Trust becomes necessary in conditions of vulnerability and uncertainty. These conditions may be especially relevant to the experience and treatment of mental illness - not least psychosis. There currently exists a paucity of research into trust and mental health services.Aims and objectivesTo develop an understanding of trust as it relates to psychosis services and their users. To identify practical contexts where trust may be particularly relevant and where research may inform policy, service organization and individual practice.MethodSemi-structured interviews were carried out with 21 stakeholders - service-users, professionals, managers, carers - across 3 different types of service working with people experiencing psychosis: early intervention; assertive outreach; and a more standard community mental health team.FindingsTrust appears to be salient and yet problematic for mental health services, not least in terms of approachability, disclosure and cooperation with treatment programmes. Organizing services around understandings of trust, rather than risk, may be more effective both at meeting need and managing risk.ConclusionsThrough an improved understanding of trust and its effect on the engagement of service-users, there are clear potential benefits for mental health services through an enhanced ability to facilitate access and develop effective cooperation towards healthcare outcomes.

Health Reform and the Scope of Benefits for Mental Health and Substance Use Disorder Services

The Patient Protection and Affordable Care Act will expand insurance coverage to millions of Americans with mental disorders. One particularly important implementation issue is the scope of mental health and substance abuse services under expanded health insurance coverage. This article examines current public and commercial insurance coverage of the range of services used by individuals with mental illnesses and substance use disorders and assesses the implications of newly mandated standards for benefit packages offered by public and private plans. The authors note that many services needed by individuals with mental or substance use disorders fall outside the scope of benefits currently covered by a typical private insurance plan. Compared with other insurers, Medicaid currently covers a broader range of behavioral health services; however, individuals moving into Medicaid under new eligibility pathways will receive "benchmark" or "benchmark-equivalent" coverage rather than full Medicaid benefits. If behavioral health benefits are set at those currently available in typical private plans or in benchmark coverage, some newly insured individuals with mental illnesses or substance use disorders who are covered by private plans or Medicaid expansions are still likely to face gaps in covered services. Policy makers have several options for addressing these likely gaps in coverage, including requiring states to maintain coverage of some support services, including certain behavioral health services in the "essential benefits package," and expanding eligibility for full Medicaid benefits.

Health Reform and the Scope of Benefits for Mental Health and Substance Use Disorder Services

Health Reform and the Scope of Benefits for Mental Health and Substance Use Disorder Services

Influence of Sex and Age on Inpatient Rehabilitation Outcomes Among Older Adults With Traumatic Brain Injury

Graham JE, Radice-Neumann DM, Reistetter TA, Hammond FM, Dijkers M, Granger CV. Influence of sex and age on inpatient rehabilitation outcomes among older adults with traumatic brain injury. Objective To assess the influence of sex and age on inpatient rehabilitation outcomes in a large national sample of older adults with traumatic brain injury (TBI). Design Prospective case series. Setting Eight hundred forty-eight inpatient rehabilitation facilities that subscribe to the Uniform Data System for Medical Rehabilitation. Participants Patients (n=18,413) age 65 years and older admitted for inpatient rehabilitation after TBI from 2005 through 2007. Interventions None. Main Outcome Measures Rehabilitation length of stay, discharge FIM motor and cognitive ratings, discharge setting, and scheduled home health services at discharge. Results Mean age ± SD of the sample was 79±7 years, and 47% were women. In multivariable models, higher age was associated with shorter lengths of stay ( P<.001), lower discharge FIM motor and cognitive ratings ( P<.001), and greater odds of home health services at discharge ( P<.001). Women demonstrated shorter lengths of stay ( P=.006) and greater odds of being scheduled for home health services at discharge ( P<.001) than men. The sex-by-age interaction term was not significant in any outcome model. Sex differences and trends were consistent across the entire age range of the sample. Conclusions Sex and age patterns in rehabilitation outcomes among older adults with TBI varied by outcome. The current findings related to rehabilitation length of stay may be helpful for facility-level resource planning. Additional studies are warranted to identify the factors associated with returning to home and to assess the long-term benefits of combined inpatient rehabilitation and home health services for older adults with TBI.

Trust in Mental Health Services: A neglected concept

Background: Research suggests that trust is vital for quality healthcare and effective outcomes. Trust becomes necessary in conditions of vulnerability and uncertainty. These conditions may be especially relevant to the experience and treatment of mental illness. There exists a paucity of research into trust and mental health services.Aims: To develop an understanding of trust as it relates to mental health services and their users. To identify practical contexts where trust may be particularly relevant and where research may inform policy, service organization and individual practice.Method: Review of wider literature on “trust” and application of these conceptualizations to the context of mental healthcare.Findings: Trust appears to be salient and yet problematic for mental health services, not least in terms of approachability, disclosure and cooperation with treatment programmes. Organizing services around understandings of trust, rather than risk, may be more effective both at meeting need and managing risk.Conclusions: Through an improved understanding of trust and its effect on the engagement of service-users, there are clear potential benefits for mental health services through an enhanced ability to facilitate access and develop effective cooperation towards healthcare outcomes. Research is required to inform policy, service organization and clinical practice to this end.

Factor structure of the Multnomah Community Ability Scale – longitudinal analysis

Community mental health services benefit from measuring clinical outcomes relevant to a community-based context in contrast to medically modeled outcomes. The Multnomah Community Ability Scale (MCAS) addresses broad dimensions of community functioning and was developed for clinical and evaluation purposes. We assessed the structural consistency and fit of the scale as a measure of community functioning through confirmatory factor analysis using a longitudinal sample of individuals ( n = 408) with severe and persistent mental illness receiving services from community mental health programs. None of the previously hypothesised factor solutions achieved a good fit and a high degree of invariance over time was observed. Through exploratory factor analysis, the possibility of alternative solutions was explored. After exclusion of two of the 17 items, four models – including four-, three-, two- and one-factor solutions - were tested for fit and invariance with no improvement. We discuss our findings of poor fit under the assumption that the MCAS should psychometrically behave as a scale. Alternative interpretations for the tool and suggestions for the use of its items as an index that measures aspects of disability are proposed.

Ethische und empirische Grenzen randomisierter kontrollierter Studien

In assessing the benefits of health services it is presumed that the relationship of cause and effect can be determined by scientific methods. In general, the randomized controlled trial (RCT) is considered the gold standard for the generation of scientific evidence. Yet there is an increasing amount of data indicating that not in all situations RCTs seem to be the adequate tool for generating evidence. In many instances, RCTs are, in fact, barely useful to reflect the real-world situation of health-care services. Some of the well-known yet mostly ignored limitations of RCTs are summarized.The absence of definite a priori preferences for a specific kind of intervention (equipoise) is an essential prerequisite for both physicians' and patients' consent to participate in an RCT. Numerous examples of quantitative studies confirm that the willingness to accept randomization is limited in operative disciplines. If it is true that the invasiveness of a diagnostic or therapeutic intervention correlates with the preferences of doctors and patients, the small number of RCTs in operative fields should be expected. Further development of the important concept of RCTs should specify the conditions under which RCTs can generate significant results. Paying attention to this will open up new perspectives for the assessment of health-care services.

The Canadian Forces Virtual Library (CFVL)

ABSTRACT This article describes the development and growth of the Canadian Forces Virtual Library (CFVL), a collection of electronic resources for education and professional development available to military and civilian staff of the Canadian Department of National Defence. The CFVL aims to provide the maximum of depth and breadth of content within the special conditions of its environment: English/French bilingualism, secure military computer networks and a large, sometimes far flung organization with many remote or “nomadic” users. The Canadian Forces Health Services benefits from the most recent expansion with the addition of six health and medicine databases from Ebsco.

The Association Between Aging Inmate Housing Management Models and Non-Geriatric Health Services in State Correctional Institutions

One of the current debates in the literature on aging inmates asks, what is the most efficient housing/health care model for this “special needs” population? State and federal correctional systems place elderly inmates either in specialized segregated housing units away from the general inmate population, consolidate elderly inmates in housing units within the prison, or provide a combination of both models. In general, proponents of the segregated housing model argue that aging inmates will receive specialized medical services in geriatric units. However, proponents of consolidated housing model argue that aging inmates will have the benefit of both geriatric and non-geriatric health services. This paper examines the association between the type of housing management model for aging inmates and the availability of non-geriatric physical and mental health services. Data for the analysis come from the 2000 Bureau of Justice Statistics Census of State and Federal Adult Correctional Facilities. The results suggest that institutions offering consolidated geriatric care provide more mental health services and that these effects are independent of the characteristics of prison facility.

Needs for and Barriers to Correctional Mental Health Services: Inmate Perceptions

Needs for and Barriers to Correctional Mental Health Services: Inmate Perceptions

A systematic evaluation of payback of publicly funded health and health services research in Hong Kong

BackgroundThe Health and Health Services Research Fund (HHSRF) is dedicated to support research related to all aspects of health and health services in Hong Kong. We evaluated the fund's outcomes and explored factors associated with the translation of research findings to changes in health policy and provider behaviour.MethodsA locally suitable questionnaire was developed based on the "payback" evaluation framework and was sent to principal investigators of the completed research projects supported by the fund since 1993. Research "payback" in six outcome areas was surveyed, namely knowledge production, use of research in the research system, use of research project findings in health system policy/decision making, application of the research findings through changed behaviour, factors influencing the utilization of research, and health/health service/economic benefits.ResultsPrincipal investigators of 178 of 205 (87%) completed research projects returned the questionnaire. Investigators reported research publications in 86.5% (mean = 5.4 publications per project), career advancement 34.3%, acquisition of higher qualifications 38.2%, use of results in policy making 35.4%, changed behaviour in light of findings 49.4%, evidence of health service benefit 42.1% and generated subsequent research in 44.9% of the projects. Payback outcomes were positively associated with the amount of funding awarded. Multivariate analysis found participation of investigators in policy committees and liaison with potential users were significantly associated with reported health service benefit (odds ratio [OR]participation = 2.86, 95% confidence interval [CI] 1.28–6.40; ORliaison = 2.03, 95% CI 1.05–3.91), policy and decision-making (ORparticipation = 10.53, 95% CI 4.13–26.81; ORliaison = 2.52, 95% CI 1.20–5.28), and change in behavior (ORparticipation = 3.67, 95% CI 1.53–8.81).ConclusionThe HHSRF has produced substantial outcomes and compared favourably with similar health research funds in other developed economies. Further studies are needed to better understand the factors and pathways associated with the translation of research findings into practice.

Rising to the challenges of achieving day surgery targets

Day surgery provides high quality and efficient care for a wide variety of surgical procedures. Patients appreciate the rapid recovery and effective analgesia, while the health service benefits from a streamlined service with lower costs. Despite the numerous advantages, day surgery practices vary enormously and many patients are still denied this excellent form of care. Fundamental to improving this situation is a change in emphasis, with day surgery becoming the default option for many surgical procedures--rather than being applied selectively--with inpatient care being used only where specifically indicated. Appropriate patient preparation is facilitated by consultant-led, nurse-run pre-assessment using modern selection criteria; only conditions which will still cause problems a few hours beyond the end of the operation should be barriers to day surgery. Pre-assessment also provides an excellent opportunity to begin patient education and ensures that pre-existing pathology is optimally treated. Efficient day surgery is best delivered by a specialised, dedicated, multi-disciplinary team, but consultant anaesthetists have a major role to play in co-ordinating policies and providing leadership. Individual anaesthetists should develop techniques that allow their patients to undergo day surgery with minimum stress, maximum comfort and the optimal chance of early discharge. Improving day surgery rates is a win-win situation, with both clinical and financial benefits.

Elimination of Methadone Benefits in the Oregon Health Plan and Its Effects on Patients

Elimination of Methadone Benefits in the Oregon Health Plan and Its Effects on Patients