Outpatient Health Care Settings Research Articles

HIV Service Provision for People with Severe Mental Illness in Outpatient Mental Health Care Settings in New York

SUMMARY People with severe mental illness evidence significantly higher rates of HIV infection than the general population in the United States. Frequently, the only access to health care for this population is through their outpatient mental health care providers. In order to determine how these providers were dealing with the increased risk of HIV infection among this group, a survey of all licensed and certified outpatient mental health care centers in New York State was conducted. The data were compared to a similar previous survey conducted in 1997.

Using Evidence-Based Practice to Reduce Central Line Infections

Central venous catheters (CVCs) are used commonly in a variety of inpatient and outpatient healthcare settings. Catheterrelated bloodstream infections (CRBSIs) contribute to 2,400–20,000 deaths per year, with an estimated cost of $296 million to $2.30 billion (Hu, Veenstra, Lipsky, & Saint, 2004). CRBSIs can be reduced dramatically with maximal barrier precautions, chlorhexidine gluconate skin preparatory agents, and strict hand hygiene.

A stochastic model for a visit to the doctor’s office

This paper presents a stochastic model of an individual patient’s experience during a visit to a doctor’s office. The stochastic model is based on tracking the visit of patients at a local family practice clinic. A rigorous, iterative procedure for model development allows the stochastic model to be constructed, evaluated, and validated to establish consistency with both the theoretical stochastic assumptions and the clinic’s actual operating environment. This model extends the use of stochastic models in health care in two important respects. First, the stochastic model represents an application of semi-Markov processes in outpatient health care settings. Second, through the use of the infinitesimal generator associated with the transition probability matrices governing patient flow, numerical predictions for first passage times are easily obtained.

The Added Value of Claims for Cancer Surveillance

As cancer diagnosis and treatment has moved to the outpatient healthcare setting, traditional cancer surveillance tools are less effective for complete and unbiased capture of incident cases. This study evaluates the potential for Medicare data to supplement cancer surveillance in a unique manner by using a standard that is independent of a central cancer registry. State cancer registry records were matched with Medicare data. Case validation included inpatient record abstraction combined with a mail/telephone survey of treating physicians. The positive predictive value (PPV), sensitivity (capture rate), and potential additional cases were calculated for 6 Medicare claims-based case definitions. The PPV varied according to cancer site and definition, ranging from 70%-97% (prostate) to 87%-98% (breast). Sensitivity varied inversely with PPV, ranging from 51%-94% (breast) to 10%-88% (lung). The most important factors that predicted being missed by the registry were having no admission to an ACOS-certified hospital and no surgical treatment. Medicare data represent a valid resource for supplementing state cancer registries in surveillance efforts. This potential is especially applicable to cancers predominantly diagnosed and treated outside the hospital setting.

Guidelines for the Prevention of Intravascular Catheter–Related Infections

AbstractThese guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device–Related Infections published in 1996. These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.

A comparison of ordinal analysis techniques in medical resource usage research

Abstract Ordinal data is prevalent in medical outcomes research; for example, gender, living condition, and use of assistive devices are all both critical explanatory factors in determining the efficacy of medical procedures and are nominal or ordinal data. One basic objective of this study was to compare four assignment (ordinal analysis techniques') prediction of expected patient resource requirements in a specialty ambulatory (outpatient) health care setting. Data from 2427 patient discharges from 7 specialty low vision clinics were collected. Biographical and discharge characteristics of patients were used to develop homogeneous patient groups on the basis of resource use. Resource-use features were then stripped from the data. The four ordinal analysis techniques were subsequently applied to the reduced data set to predict iso-resource group membership for each patient in the data. Chance criterion was used as a benchmark in gauging the predictive ability of each ordinal analysis technique. Prediction results obtained were clinic-specific. This may largely be explained by the fact that the initial iso-resource groups were unique to each clinic and no meaningful iso-resource groups could be obtained from combined data across clinics. No technique was found to be universally superior at all clinics, however, each technique's performance across clinics was consistently better than the benchmark. Contrary to initial expectations, neural networks, in some cases, significantly underperformed the more traditional techniques.

Are Latinos less satisfied with communication by health care providers?

To examine associations of patient ratings of communication by health care providers with patient language (English vs Spanish) and ethnicity (Latino vs white). A random sample of patients receiving medical care from a physician group association concentrated on the West Coast was studied. A total of 7,093 English and Spanish language questionnaires were returned for an overall response rate of 59%. Five questions asking patients to rate communication by their health care providers were examined in this study. All five questions were administered with a 7-point response scale. We estimated the associations of satisfaction ratings with language (English vs Spanish) and ethnicity (white vs Latino) using ordinal logistic models, controlling for age and gender. Latinos responding in Spanish (Latino/Spanish) were significantly more dissatisfied compared with Latinos responding in English (Latino/English) and non-Latino whites responding in English (white) when asked about: (1) the medical staff listened to what they say (29% vs 17% vs 13% rated this "very poor," "poor," or "fair"; p <.01); (2) answers to their questions (27% vs 16% vs 12%; p <.01); (3) explanations about prescribed medications (22% vs 19% vs 14%; p <.01); (4) explanations about medical procedures and test results (36% vs 21% vs 17%; p <.01); and (5) reassurance and support from their doctors and the office staff (37% vs 23% vs 18%; p <.01). This study documents that Latino/Spanish respondents are significantly more dissatisfied with provider communication than Latino/English and white respondents. These results suggest Spanish-speaking Latinos may be at increased risk of lower quality of care and poor health outcomes. Efforts to improve the quality of communication with Spanish-speaking Latino patients in outpatient health care settings are needed.

Review: Infectious disease transmission in outpatient settings is associated with nonadherence to infection control procedures

EtiologySeptember 1, 1991Review: Infectious disease transmission in outpatient settings is associated with nonadherence to infection control proceduresJeff Whittle, MDJeff Whittle, MDVeterans Affairs Medical Center, Pittsburgh, Pennsylvania, USA (J.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-1991-115-2-062 SectionsAboutFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationGoodman RA, Solomon SL. Transmission of infectious diseases in outpatient health care settings. JAMA. 1991 May 8;265:2377-81. Author, Article, and Disclosure InformationAffiliations: Veterans Affairs Medical Center, Pittsburgh, Pennsylvania, USA (J.W.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails September 1, 1991Volume 115, Issue 2Page: 62KeywordsAcupunctureChiropracticDisinfectionEpidemiologyEquipment sterilizationHIVHepatitis BHepatitis B virusHerpes simplexInfectious diseasesInformation storage and retrievalInpatientsMedical dialysisNontuberculous mycobacteriaNutritionOutpatient clinicsOutpatientsProspective studiesVaccines ePublished: 9 March 2020 Issue Published: September 1, 1991 Copyright & PermissionsCopyright © 1991 by American College of Physicians. All Rights Reserved.Loading ...

Transmission of infectious diseases in outpatient health care settings

Increased provision of health care in outpatient settings and concerns about occupational transmission of infections have focused attention on the risk of transmission of infectious diseases in ambulatory health care settings. In contrast to inpatient nosocomial infections, infections transmitted in outpatient settings are neither systematically monitored nor likely to be detected by routine qi surveillance. To better define the spectrum of such events, we reviewed the literature to identify cases and clusters of infections associated with outpatient health care. In this review, we identified and epidemiologically characterized 53 such reports that occurred from 1961 through 1990. Transmission occurred in general medical offices, clinics, and emergency departments (23); ophthalmologists' offices and clinics (11); dental offices (13); and alternative-care settings (six). Our findings suggest that inpatient infection-control practices should be extended to outpatient health care settings by assigning specific responsibility for infection control and by adapting surveillance methods and prevention measures. (<i>JAMA</i>. 1991;265:2377-2381)

Transmission of Infectious Diseases in Outpatient Health Care Settings

Increased provision of health care in outpatient settings and concerns about occupational transmission of infections have focused attention on the risk of transmission of infectious diseases in ambulatory health care settings. In contrast to inpatient nosocomial infections, infections transmitted in outpatient settings are neither systematically monitored nor likely to be detected by routine qi surveillance. To better define the spectrum of such events, we reviewed the literature to identify cases and clusters of infections associated with outpatient health care. In this review, we identified and epidemiologically characterized 53 such reports that occurred from 1961 through 1990. Transmission occurred in general medical offices, clinics, and emergency departments (23); ophthalmologists' offices and clinics (11); dental offices (13); and alternative-care settings (six). Our findings suggest that inpatient infection-control practices should be extended to outpatient health care settings by assigning specific responsibility for infection control and by adapting surveillance methods and prevention measures.