Provision Of Inpatient Services Research Articles

Far from Home: Women’s Experiences of Being in Secure Forensic Inpatient Services

Specialist secure mental health inpatient service provision for women in England and Wales is limited, and beds are often commissioned in out-of-area services to meet their mental health and risk management needs. In North Wales, there are no NHS beds for women at any secure level, and most women are placed out-of-area in South Wales or England. The current study aimed to explore the experiences of women from North Wales who had resided in out-of-area secure inpatient services, using Interpretative Phenomenological Analysis (IPA) methodology. Participants described the challenges that they and their families experienced when in services at a great distance from their home areas. Services responded to women’s expressions of distress with restrictive interventions, including physical restraint and seclusion, exacerbating their sense of isolation. Participants voiced a desire to return home and viewed returning to Wales as indicative of progress they had made. This is thought to be the first study involving women from across the secure pathway, from high secure to the community. The findings are explored in relation to existing literature and study limitations are discussed.

Overwhelming number of refugees in Poland - which strategy is being pursued

AbstractBy the decision of the Polish Government, all persons arriving in the territory of the Republic of Poland after the commencement of the Russian aggression against Ukraine have free access to public psychiatric assistance, including reimbursement of pharmacological treatment on the same terms as Polish citizens. According to the UHNR data over 4 million displaced people, refugees, came to Poland so far and some of them benefited from such help.Displaced individuals suffer from the consequences of traumatic events, exhibit psychological problems or develop mental disorders, including post-traumatic stress disorder, depressive and anxiety disorders or relapses of psychotic episodes.The lecture will present data from the Interdisciplinary War in Ukraine Research Laboratory by pointing out the most important problems faced by Ukrainian refugees in Poland, why they chose Poland when escaping the war, how they evaluate Polish help, what their integration in Poland looks like. The survey also measured the level of war trauma (RHS-15). The results of the analysis show that most refugees present post-traumatic stress disorder symptoms (76 %), while only 0.15% of this population was treated in public psychiatric facilities.Mental healthcare services are suddenly faced with major challenges and need to develop or expand strategies to address them. The Polish Ministry of Health prepared and started implementation of a reform of the mental health care system for adult as well as children and adolescent psychiatry. This fundamental reform should comprise three main actions, i.e. integration of mental health services into primary healthcare; establishment of community psychiatric services together with the provision of inpatient services in general hospitals; and limitation of the role of mental hospitals to specific tasks only (long-term or specialist treatment).Disclosure of InterestNone Declared

Ideal models of good inpatient care for adults with intellectual disability: Lessons from England.

In recent years, a significant proportion of inpatient facilities for people with intellectual disabilities and/or autism has been de-commissioned in England, This has resulted in individuals with intellectual disabilities being sent to distant hospitals far away from their families and carers leading to challenges in follow-up, community care and interventions. The impact of de-institutionalisation, has often caused patient trauma, family distress and subsequent discharge difficulties. Not every individual with intellectual disabilities and/or autism requires inpatient care but inpatient care when needed has to be local, adequate and appropriate. To evaluate current evidence of utility of inpatient models for people with intellectual disabilities and outline best clinical practice. PubMed, CINAHL, EMBASE, Cochrane Library, Scopus, Web of Science were searched with key search terms. The search was conducted by the information specialist and identified abstracts screened further for inclusion criteria, methodological issues, and other appropriate characteristics. Twenty-three papers were included in the rapid review. Papers shortlisted had the inclusion criteria applied against the full text version independently by two reviewers. Disagreements regarding eligibility of studies was resolved by discussion and consensus within the project team. Key data related to in-patient models of care was extracted from the included papers, which included year of study, design, study objectives, target population, method/s tested, outcomes reported, country of study/studies, and results. Data extraction was performed by two reviewers and reviewed by the project team. From the review of services for people with intellectual disabilities, we came across four broad models/frameworks/approaches. Evidence on what worked for inpatient service provision tended to be based on models developed and implemented locally. We make recommendations for the best clinical practice and standards. Both clinical service providers and policymakers need to be aware of specific needs of individuals with intellectual disability and/or autism.

Hospice inpatient services provision, utilization, and financial performance.

Hospice performance is an overlooked area in the health care field due to the difficulty of measuring quality of care and the infrequent quality inspection. Based on the daily reimbursement mechanism for different levels of hospice care, inpatient services provision could influence both hospice-level length of stay (LOS) and financial performance. The objective of this study was to explore the relationship between hospice inpatient services provision and hospice utilization and financial performance. A longitudinal secondary data set (2009-2013) was merged from three sources: (a) Hospice Cost Reports from the Centers for Medicare & Medicaid Services, (b) the Provider of Services files, and (c) the Area Health Resources Files. The dependent variable in this study was hospice average LOS and financial performance measured by total operating margin (TOM) and return on assets. The independent variable was hospice inpatient services' offering. Mixed-effects regression models were used in the multivariate regression analyses. When comparing to hospices not providing inpatient services, offering inpatient services by staff was negatively related to average LOS (b = -0.063, p < .05) and TOM (b = -0.022, p < .05). The combination method with providing inpatient services by staff and under arrangement was negatively associated with return on assets (b = -0.073, p < .05). Hospice inpatient services provision was associated with average LOS and financial performance. Offering the inpatient services to patients by staff decreased average LOS and TOM. Hospice agencies may seek strategies to maintain their financial sustainability through outsourcing.

Patients' Satisfaction with Inpatient Services in Selected Wards of Some Hospitals Affiliated to Yazd Shahid Sadoughi University of Medical Sciences in 2016

Introduction: Patient satisfaction with health care indicates the organizational performance of a hospital. The level of patient satisfaction depends on factors such as ability of the physician, observance of the patient's rights, and quality of treatment. The aim of this study was to investigate the level of patient satisfaction with the provision of inpatient services in selected wards of some hospitals affiliated to Yazd Shahid Sadoughi University of Medical Sciences in 2016. Methods: The present study was a descriptive cross-sectional research. Shahid Sadoughi, Shahid Rahnemoun, Afshar, Ziaei Ardakan, and Fatemeh Al-Zahra Mehriz hospitals were selected to conduct the study. Inpatients were included in the statistical population. The total sample size with an error of 5% was estimated at 1056 people. A researcher-made questionnaire was applied to collect the study data. Data analysis was performed using SPSS software version 21 and frequency, mean, median, and exponential distribution tables were used to describe the findings. Results: The initial population was estimated at 83531 people. In order to reduce the error, a higher sample size (1527 people) was considered. The highest number of patients was from Afshar Hospital (24.6%). The average level of patient satisfaction with the physician was 4.30, with the nursing services was 4.23, with the nursing assist services was 4.25, with the service staff was 4.45, and with the welfare facilities was 4.33. Patients' satisfaction with the service staff was higher than other dimensions. In total, 95.2% of patients were satisfied with the provided services. Conclusion: The authorities are recommended to plan the necessary interventions in order to improve the quality of care provided by medical personnel and eliminate patients’ dissatisfaction with the help of hospital officials. To this end, the patient rights should be observed by all personnel.

Hospice Inpatient Services Provision, Utilization, and Financial Performance

Background: Hospice performance is an overlooked area in the health care field due to the nature of hospice care and the infrequent hospice quality inspection. Purpose: The objective of this study is to explain differences in the financial performance of hospices with regard to hospice inpatient services provision when considering the average length of stay (LOS) in the relationship. Methodology/Approach: A longitudinal secondary data set (2009 to 2013) was merged from three sources: (a) Hospice Cost Reports from the Centers for Medicare and Medicaid Services (CMS), (b) the Provider of Services (POS) files, and (c) the Area Health Resources Files (AHRF). The dependent variable in this study was hospice financial performance measured by total margin (TM) and return on assets (ROA). The independent variable was hospice inpatient services’ offering. Mixed effects regression models were used in the multivariate regression analyses. The mediation effect of hospice average LOS in the relationship between hospice inpatient services’ provision and two financial performance measures was also tested. Results: The presence of hospice inpatient services was negatively related to average LOS (ß =-0.050; p<0.01), total margin (TM) (ß =-0.028; p<0.01), and return on assets (ROA) (ß =-0.059; p<0.01). However, average LOS was positively associated with TM (ß =0.077; p<0.01) and ROA (ß =0.177; p<0.01). The relationship between hospice inpatient services’ offering and financial performance was partially mediated by hospice average LOS. Conclusion: Hospice inpatient services provision and average LOS were associated with financial performance. Practice Implications: Offering the inpatient services to patients decreased average LOS and lowered the hospices’ overall profitability. Hospice agencies need to seek strategies to maintain their financial sustainability but not to compromise their quality of services.

The Role of DOSA-Principle for German Hospitals

Introduction: Inpatient admission on the day of surgery – in jargon “Day of Surgery Admission” (DOSA) is an in many countries widely introduced care principle. There it is already implemented in the treatment standards and combined with fixed target rates. Advantages like higher patient sa-tisfaction, reduction of nosocomial infections or higher cost effectiveness have been proved by earlier studies. German hospitals focus primarily on the punctual start of surgical procedures, op-timization of transition times between two surgeries or surgical management. Some of them are already working with the DOSA principle. The study analyzes the current implementation rate of DOSA in Germany and the hidden financial potential of a consistent implementation. Case Presentation: Underlying data include the routinely compiled inpatient documentation of German hospitals as well as the results of the annual quality reports and the hospital benchmark of IGES Institute. The study analyzes if and if so, to which extend the DOSA principle is already im-plemented in German inpatient care for the surgical procedure of cholecystectomy. Based on the assumption that a DOSA rate of 85% for eligible patients is feasible financial savings are then es-timated for the case that preoperative inpatient days could be reduced by one day per case (for non-DOSA cases). The results are then translated into an estimation for the whole inpatient sector and sorted by major diagnostic categories (only for procedures with operative codes relevant for grouping in the contract for ambulatory surgeries). Conclusion: In 2013 the preoperative inpatient period for cholecystectomy procedures averaged at 2.1 days per case. The DOSA-rate for those surgeries was at 47.6 percent. That translates into a DOSA potential of approx. 46,000 occupancy days or 126 hospital beds (reduction by one preoperative inpatient day per case). The financial impact of a consistent implementation results in 11.9 million Euro of savings solely for gall bladder surgeries (260.54 Euro per case). In case the number of preoperative inpatient days is reduced to zero for eligible cases the savings would increase up 25.1 million Euro (547.13 Euro per case) or approx. 265 hospital beds. Considering not only cholecystectomy but a nearly complete set of DOSA relevant procedures the analysis for those surgeries results in a DOSA potential of 510,774 cases per year and 138 million Euro in savings. The scale of the calculated figures in this projection evoked by consistent implementation of the DOSA principle is of significant relevance to individual hospitals, as well as the entire inpatient service provision in Germany.

Prioritization of inpatient hospital services to prisoners: a method for justifying care and costs.

As a response to rising health care costs and substantial cuts in state funding for correctional health care in Texas, we developed and applied a process framework for systematically prioritizing the provision of inpatient hospital services to prisoners. Specifically, all inpatient services provided from September 2009 through August 2011 at the University of Texas Medical Branch/Texas Department of Criminal Justice Hospital were sorted according to levels of care consistent with those previously defined by the Oregon Department of Corrections and the Federal Bureau of Prisons. Nearly all inpatient services (94%) were deemed medically mandatory (Level 1) or medically necessary (Level 2). These services must be funded to ensure an adequate level of care, and capitated-funding mechanisms may not be sufficiently flexible to cover their costs. Correctional health care systems may adapt the framework used here to inform state policymakers regarding provision of inpatient services and funding requirements.

Erratum to: Hospital Readmission Among Medicaid Patients with an Index Hospitalization for Mental and/or Substance Use Disorder

Hospital readmission rates are increasingly used as a performance indicator. Whether they are a valid, reliable, and actionable measure for behavioral health is unknown. Using the MarketScan Multistate Medicaid Claims Database, this study examined hospital- and patient-level predictors of behavioral health readmission rates. Among hospitals with at least 25 annual admissions, the median behavioral health readmission rate was 11% (10th percentile, 3%; 90th percentile, 18%). Increased follow-up at community mental health centers was associated with lower probabilities of readmission, although follow-up with other types of providers was not significantly associated with hospital readmissions. Hospital average length of stay was positively associated with lower readmission rates; however, the effect size was small. Patients with a prior inpatient stay, a substance use disorder, psychotic illness, and medical comorbidities were more likely to be readmitted. Additional research is needed to further understand how the provision of inpatient services and post-discharge follow-up influence readmissions.

Hospital Readmission Among Medicaid Patients with an Index Hospitalization for Mental and/or Substance Use Disorder

Hospital readmission rates are increasingly used as a performance indicator. Whether they are a valid, reliable, and actionable measure for behavioral health is unknown. Using the MarketScan Multistate Medicaid Claims Database, this study examined hospital- and patient-level predictors of behavioral health readmission rates. Among hospitals with at least 25 annual admissions, the median behavioral health readmission rate was 11% (10th percentile, 3%; 90th percentile, 18%). Increased follow-up at community mental health centers was associated with lower probabilities of readmission, although follow-up with other types of providers was not significantly associated with hospital readmissions. Hospital average length of stay was positively associated with lower readmission rates; however, the effect size was small. Patients with a prior inpatient stay, a substance use disorder, psychotic illness, and medical comorbidities were more likely to be readmitted. Additional research is needed to further understand how the provision of inpatient services and post-discharge follow-up influence readmissions.

Pacientų mokėjimų, sutikimo ir galimybių mokėti už sveikatos priežiūros paslaugas lygybės aspektai

In Lithuania, out-of-pocket patient payments (OOP) in health sector have been the focus of political debates for many years. Pharmaceutical costs constitute a major share of private expenditure on health. However, the OOPs for services both official and unofficial (including quasi official) are significant. The aim of the paper is to present the outcomes of the analysis addressed to patient’s characteristics influencing the OOPs for health services and individual willingness to pay (WTP) as well as inequality dimensions of the OOPs in Lithuania. It is the first outcome of the analysis of the data collected in July, 2010, within the international collaborative project “Assessment of patient payment policies and projection of their efficiency, equity and quality effects. The case of Central and Eastern Europe”. The study was financed by the European Commission under FP7 Theme 8 Socio-economic Sciences and Humanities, Project ASSPRO CEE 2007 (GA no. 217431). The content of the publication is the sole responsibility of the author and it in no way represents the views of the Commission or its services.The data on the OOPs were collected through a nationally representative survey (N=1012) in July, 2010, using face-to-face interviews based on a standardized questionnaire. The questionnaire was discussed with external experts and pre-tested in a pilot study.During the period of July, 2009 – June, 2010, patients spent on average 146 litas7 for health services or, recalculated for those, who actually paid for the services (about 37% of adult population), 325 litas. Official average payment for outpatient consultation equals 64.6 litas, unofficial one – 72.8 litas. Despite negligible private provision of inpatient services and the declared “all included” hospital services, official average payment in hospital was about 246 (7–200) litas; unofficial payments for inpatient services were the most frequent within the corresponding patients’ group, when almost a half of the patients paid 158 (0.5–1600) litas per hospitalization.Males and the poorest population paid for healthcare less frequently in opposite to more frequent payments among those, who were not satisfied with the quality of the services. Moreover, almost 58 percent of the population agreed to pay officially for better quality services in a case of facing serious threat to their health. In less severe cases, the WTP was even higher when 82 percent, and 71 percent of the respondents agreed to pay officially on average 42 litas and 355 litas for outpatient and inpatient services, respectively. The WTP for the outpatient services was the lowest among the poorest and country-side citizens, as well as those, who had a lower education level. At the same time, living in cities, single persons and those, who had not paid for inpatient services, were determinants for reducing the WTP for the inpatient services. Unemployed and single persons with 10 times higher probability would not agree to pay officially for the outpatient services.About 21.8 percent of the respondents (N=980) said that they needed but could not afford and did not use the outpatient services at least once a year. Regarding the inpatient services, a share of the patients rejecting the services was much less – 3.3 percent.In 2010, the actual (and in less degree accepted) OOPs in Lithuania were regressive (Kakwani index -0.279 and -0.223 correspondingly).

Introduction of the German case tariff fee system and its effects on patient satisfaction in inpatient naturopathy

IntroductionFor certain indications, methods of classical naturopathy are now being used in German hospitals originally dedicated to the treatment of acute conditions using orthodox medicine. Because the hospital sector currently represents the focal point of German healthcare, both professionally and economically, the introduction of the German Diagnosis-Related Groups (G-DRG) acts as an important stimulus to the process of applying business management principles to the country's health service. Against this background, the present study examines effects on patient satisfaction as a quality indicator of medical and nursing care in the setting of providing inpatient complementary medical treatment. MethodsBetween 2004 and 2008, randomised, blinded interviews were performed of 4598 hospitalised patients receiving treatment in an acute clinic for internal medicine focusing on naturopathy. The aim of this survey was to analyse the satisfaction with the provision of inpatient naturopathic treatment in the context of the prevailing system of hospital financing. ResultsNeither for the professions providing medical services, nor for those providing nursing services, were any significant differences detected in patient satisfaction between the two groups of patients (p>0.05). ConclusionNegative effects of a case tariff fee remuneration system on the doctor–nurse–patient relationship – which have been discussed and expected by some – could not be confirmed. The results of the survey allow the conclusion that the holistic care of patients can generate a considerable increase in patient satisfaction in the provision of inpatient services, even under the conditions of the DRG system.

Interdisciplinary complex therapies in inpatient hospital treatment in Germany: Evidence from Germany

Interdisciplinary complex therapies are rarely a part of German hospital care. The aim of this article is to provide the reader with an overview of the complex therapies currently used within the German health system. The paper first defines who is entitled to hospital treatment at all in Germany. Examples of pathway entry criteria for entitlement to interdisciplinary complex therapies are then presented. The contents are highlighted of two complex procedures which focus on the treatment of diseases and disturbances of the musculoskeletal system and connective tissue, and the importance is demonstrated of structural, process, and outcome quality for the provision of inpatient services. Complex therapies in inpatient care in Germany establish the basis for an interdisciplinary provision of services. They define minimal criteria for the organization of a hospital, enable the integration of different therapeutic approaches and, therefore, lead to an intensive and holistic treatment by a specially trained team. In this setting, aspects of process and outcome quality acquire considerable importance. The paper shows that for many patients in Germany with chronic diseases, complex therapies were designed to ensure that the patients received a high standard of interdisciplinary care during longer periods of hospitalization. Not every patient is entitled to this kind of treatment. If specific pathway entry criteria regulating provision of such treatment are met, the hospital receives higher remuneration for covering the higher costs incurred.

Mental health services for women

There is now growing evidence, from neuroscience to epidemiology and health services research, that there are significant gender differences in mental health which means that treatments and services need to be tailored for men and women. This symposium focuses on recent research findings on gender sensitive mental health services for women with severe mental illness. Women with severe mental illness have specific reproductive needs and some countries have developed psychiatric mother and baby units for perinatal illness. Two papers will be presented on reproductive needs, one from the perspective of women considering whether or not to have children, and the other presented by a service user who presents research on the experience of different services during illness and recovery from postnatal psychosis. Women are also at increased risk of domestic violence and one paper discusses the results of a pilot project to improve how mental health services respond to domestic violence. The final paper reports from a study of another alternative model of gender-specific inpatient service provision, comparing women's crisis houses with general wards. Studies used qualitative and quantitative methodologies (e.g. individual qualitative interviews, patient preference RCT, and pilot study), and some preliminary data on effectiveness and cost-effectiveness of different models of care will also be presented. Each paper demonstrates that women's mental health services need to address reproductive needs and their experiences of violence and abuse. Modern mental health services need to respond to gender-specific health and social care needs. This means developing and evaluating different models of service provision including mother and baby units, women's crisis houses and domestic violence services for women with severe mental illness. Keywords: Treatment effectiveness, Women''s health services, severe mental illness.

Issues in the provision of nursing care to people undergoing cardiac surgery who also have type 2 diabetes

There has been little investigation of the issues associated with caring for patients presenting for cardiac surgery with a comorbid diagnosis of diabetes although there is some evidence that the diabetes management is suboptimal. This study aimed to identify issues that patients and cardiac specialist nurses experience with the provision of inpatient services for people undergoing cardiac surgery who also have type 2 diabetes. A qualitative interpretive design, using individual interviews with patients and nurses, provided data about some of these issues. The study found that nurses had high levels of confidence in their cardiac care but little confidence in diabetes management. Patients described concerns about their diabetes care and treatment regimens. A 'typical journey' for a person with diabetes undergoing cardiac surgery was identified. The findings support the need to build increased capacity in specialist nurses to support diabetes care as a secondary diagnosis.

Bed/population ratios in South African public sector mental health services.

In post-apartheid South Africa, mental health service planners face critical decisions regarding appropriate and affordable inpatient care. Before a fashion of deinstitutionalisation is followed blindly in South Africa, effective community services should be in place and sufficient psychiatric beds should remain in hospitals for those who cannot be catered for in the community. In order to maintain the delicate balance between hospital and community-based services, it is essential that useful indicators of inpatient care are established. This study documents current bed/population ratios per 100 000 population in public sector mental health services in South Africa. A questionnaire was distributed to provincial mental health coordinators requesting psychiatric bed numbers in acute and medium-long stay facilities across all service levels. The information was supplemented by consultations with mental health coordinators in each of the nine provinces. Population data were obtained from preliminary findings of the 1996 census. For acute facilities, the mean bed/population ratio was 13 (provincial range: 6-18) per 100 000 population. For medium-long stay facilities, it was 16 (provincial range: 0-29) excluding contracted facilities, and 35 (provincial range: 0-83) including contracted facilities per 100 000 population. There were low levels of inpatient service provision in South Africa, and there was considerable variability between provinces. This study gives further support to the need to develop acute inpatient psychiatric services, reduce levels of chronic care where appropriate, and redirect resources towards the development of community-level residential and day-care services. It is crucial to develop accurate indicators to monitor this process.

Providing care at the end of life: do Medicare rules impede good care?

Providing care at the end of life: do Medicare rules impede good care?

The Medicare Hospice Benefit—15 Years of Success

Journal of Palliative MedicineVol. 1, No. 2 Special Series—The Medicare Hospice Benefit: An Appraisal at 15 YearsThe Medicare Hospice Benefit—15 Years of SuccessJohn J. MahoneyJohn J. MahoneySearch for more papers by this authorPublished Online:19 Apr 2005https://doi.org/10.1089/jpm.1998.1.139AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byHospice inpatient services provision, utilization, and financial performance12 November 2020 | Health Care Management Review, Vol. 46, No. 4Engaging Heart Failure Clinicians To Increase Palliative Care Referrals: Overcoming Barriers, Improving Techniques Laura P. Gelfman, Jill Kalman, and Nathan E. Goldstein3 July 2014 | Journal of Palliative Medicine, Vol. 17, No. 7Ethnic differences in hospice enrollment following inpatient palliative care consultation10 September 2013 | Journal of Hospital Medicine, Vol. 8, No. 10Health Care Costs in End-of-Life and Palliative Care: The Quest for Ethical ReformJournal of Social Work in End-Of-Life & Palliative Care, Vol. 7, No. 4Service Learning Collaborations: A Formula for Reciprocity3 May 2018 | Families in Society: The Journal of Contemporary Social Services, Vol. 91, No. 2How do surrogate decision makers describe hospice? Does it matter?5 September 2016 | American Journal of Hospice and Palliative Medicine®, Vol. 23, No. 2Determinants of Hospice Home Care Use Among Terminally Ill Cancer PatientsNursing Research, Vol. 52, No. 4Barriers to Hospice Care Among Older Patients Dying With Lung and Colorectal CancerJournal of Clinical Oncology, Vol. 21, No. 4Pain Reports by Older Hospice Cancer Patients and Family Caregivers1 August 2002 | The Gerontologist, Vol. 42, No. 4PALLIATIVE CARE AND END-OF-LIFE ISSUESAnesthesiology Clinics of North America, Vol. 18, No. 1 Volume 1Issue 2Jun 1998 InformationCopyright 1998, Mary Ann Liebert, Inc.To cite this article:John J. Mahoney.The Medicare Hospice Benefit—15 Years of Success.Journal of Palliative Medicine.Jun 1998.139-146.http://doi.org/10.1089/jpm.1998.1.139Published in Volume: 1 Issue 2: April 19, 2005PDF download