The 'offset effect' of mental health treatment on ambulatory medical care utilization and charges. Month-by-month and grouped-month analyses of a five-year study.

The five-year ambulatory medical care experience of 400 patients with mental disorders was studied to test the "offset" hypothesis that patients receiving timely mental health specialist treatment have lower subsequent utilization of, and charges for, care than patients not receiving such specialist treatment. Specialist treatment was associated with significant offset savings in utilization and charges for the non-psychiatric medical care of treated patients with either severe or less severe mental disorders. However, the visits and charges for such specialist treatment boosted the overall (nonpsychiatric plus mental health specialist) care utilization and charges of the specialist-treated patients above those of patients treated solely by their nonpsychiatric physicians; this overall increase was especially pronounced for patients with severe mental disorders. The findings suggest the need for randomized prospective offset studies comparing utilization, cost, and clinical outcomes.

Evaluating nutrition intervention in atherosclerosis: some theoretical and practical considerations.

A model for assessing the economic benefits of nutrition counseling services to ambulatory populations is discussed in the context of atherosclerosis. Possible methods for detecting and quantifying the impact of nutrition intervention on atherosclerosis-related risk factors are reviewed. Clinical records in a hospital-sponsored health center were explored to see what problems might be involved in using retrospective data for evaluation. Early impressions of risk-factor improvement after nutrition intervention should encourage the needed rigorous studies to document and quantify this probable effect.