Comparing methodologies for imputing ethnicity in an urban ophthalmology clinic.

PURPOSE: To compare methodologies for imputing ethnicity in an urban ophthalmology clinic. METHODS: Using data from 19,165 patients with self-reported ethnicity, surname, and home address, we compared the accuracy of three methodologies for imputing ethnicity: (1) a surname method based on tabulation from the 2000 US Census; (2) a geocoding method based on tract data from the 2010 US Census; and (3) a combined surname geocoding method using Bayes' theorem. RESULTS: The combined surname geocoding model had the highest accuracy of the three methodologies, imputing black ethnicity with a sensitivity of 84% and positive predictive value (PPV) of 94%, white ethnicity with a sensitivity of 92% and PPV of 82%, Hispanic ethnicity with a sensitivity of 77% and PPV of 71%, and Asian ethnicity with a sensitivity of 83% and PPV of 79%. Overall agreement of imputed and self-reported ethnicity was fair for the surname method (κ 0.23), moderate for the geocoding method (κ 0.58), and strong for the combined method (κ 0.76). CONCLUSION: A methodology combining surname analysis and Census tract data using Bayes' theorem to determine ethnicity is superior to other methods tested and is ideally suited for research purposes of clinical and administrative data.

Estudio de coste-efectividad del manejo diagnóstico del derrame pleural en una unidad de patología pleural ambulatoria / Cost-Effectiveness Study of the Diagnosis of Pleural Effusion in Chest Diseases Outpatient Clinic

Objetivo: Analizar la eficacia diagnóstica de los procedimientos, seguridad, demora y costes del estudio diagnóstico del derrame pleural (DP) analizando estos parámetros en función del ámbito de manejo del paciente (ambulatorio u hospitalizado).Material y métodosEstudio prospectivo no aleatorizado. Se establecieron 2 grupos según su manejo se realizó de forma ambulatoria en una unidad específica o en régimen de hospitalización convencional, sin otro criterio de ingreso diferente al del propio estudio del DP, comparando las variables mencionadas en función del ámbito del estudio diagnóstico.ResultadosSe incluyeron 60 pacientes ambulatorios y 34 hospitalizados. La mediana de visitas en los pacientes manejados de forma ambulatoria fue de 2 (RIQ=2–3) días y la de días de estancia en los ingresados de 13 (7,7–25,2) días. El número de analíticas y estudios radiológicos fue significativamente mayor en el grupo de pacientes hospitalizados. No observamos diferencias en el número de citologías ni de biopsias pleurales, ni en las complicaciones entre ambos grupos. No hubo diferencias significativas en el tiempo hasta la realización de la tomografía computerizada pero si en el número de días hasta la realización de la biopsia pleural que fue menor en los pacientes del grupo ambulatorio al igual que el necesario hasta la obtención de un diagnóstico. El coste medio total por paciente ambulatorio fue de 1.352€ y en el ingresado de 9.793,2€.ConclusionesEl manejo diagnóstico de forma ambulatoria de pacientes con DP es altamente coste-efectivo. La efectividad y la seguridad de ambas formas de estudio es al menos similar. En este estudio el coste medio por paciente estudiado por DP en régimen hospitalizado fue 7,2 veces superior al que supone el manejo ambulatorio(AU)

Objective: To evaluate the diagnostic efficacy of pleural procedures, safety, delay and cost of the diagnosis of pleural effusion (PE) by analysing the parameters that are dependent on the area of patient management (outpatient or inpatient).Patients and MethodsProspective non-randomized study. Two groups were established depending on whether they were managed in a specific outpatient unit or as a conventional hospital inpatient, with the rest of the criteria being the same for the study of the PE.ResultsWe included 60 outpatients and 34 inpatients. The median number of visits as an outpatient was 2 (range 2–3), and the time an inpatient was hospitalized was 13 (range 7.7–25–2) days. The number of analytical and imaging studies was significantly higher in the inpatient group. There were no differences in the number of cytology and pleural biopsies, or complications between groups. There were no differences in time to performing computed tomography. The number of days until the pleural biopsy and the time until to obtain a diagnosis was lower in the outpatient group. Mean total cost for an outpatient was €1.352 and €9.793,2 for inpatients.ConclusionsManagement of ambulatory diagnosis of PE patients is highly cost-effective. The effectiveness and safety of forms of the study is at least similar. In this study, the mean cost for a hospitalised inpatient for a PE was 7.2 times higher than outpatient management(AU)

The use of ambulatory patient groups for regulation of hospital ambulatory surgery revenue in Maryland.

The Maryland Health Services Cost Review Commission (HSCRC or the commission) is a government agency with the authority to establish rates for both inpatient and outpatient services for all general acute care hospitals in the state. By law and consistent with the state's unique Medicare waiver, all payers (including Medicare and Medicaid) must pay hospitals on the basis of these rates. The HSCRC has used diagnosis related groups to set case-mix-adjusted limits on the revenue per discharge for inpatient services (similar to Medicare inpatient prospective payment nationally) yet, the Maryland rate-setting system for outpatient services has not embodied incentives to control utilization of services. Beginning in the state's fiscal year 2008, the HSCRC is implementing regulation of ambulatory surgery services using ambulatory patient groups to provide better incentives to control utilization, and to facilitate comparisons of the case-mix-adjusted charges per ambulatory surgery case across hospitals. Maryland has been an innovator in the design and successful implementation of payment systems and other incentive mechanisms to constrain hospital cost, maintain payment equity, and ensure access to needed hospital care. The HSCRC's adoption of all patient refined diagnosis related groups and the hospital-specific relative value method for establishing diagnosis related group weights in 2005 was relevant to the Centers for Medicare and Medicaid Services' decision to move to Medicare severity diagnosis related groups beginning in federal fiscal year 2008, and to consider the use of hospital-specific relative value weights. The HSCRC's decision to use ambulatory patient groups for ambulatory surgery is an attempt to apply the most effective features of inpatient payment systems, prospective payment, including incentives to control service volumes. As such, it represents a radical departure from prevailing payment arrangements in that it seeks to remove the traditional distinction between inpatient and outpatient surgical services, a distinction that has blocked the development of effective and well-integrated outpatient payment systems for decades. This article describes the policy rationale for this system, the analysis that was performed, and the methods that will be used to control the revenue per case and compare the relative charges of the hospitals.

The effects of outpatient co-payment policy on healthcare usage by the elderly in Taiwan.

Aging and declining health are intrinsically related and are resulting in increasing healthcare spending in many countries. Control of healthcare spending and patient usage behavior are linked. This study examines the healthcare usage behavior of chronically ill elderly patients in Taiwan following an increase in co-payments. The differences in usage behavior are interpreted by comparing the frequency of hospital visits and the types of hospitals chosen by patients before and after the implementation of the new co-payment policy. Claim data of the Taipei branch of the National Health Insurance Bureau (NHIB) is used as a basis for this analysis. Analysis results indicate that choice of hospital type by the elderly is affected by an increase in co-payment, but that difference of the hospital type choice before and after the co-payment increase is too small to be practically significant. However, the frequency of visits decreased significantly after the implementation of the new co-payment policy. Medical care costs per visit for individual patients and for the National Health Insurance system both increased significantly. Visit frequency and hospital type choice, as well as diagnosis and treatment cost and co-payment, all show significant differences among different age groups of the elderly. The effects of co-payment increases are also discussed from the viewpoint of patients and of governmental policy.

Evaluacion de calidad de los servicios del policlinico 32 de la CNS-CBBA / sss

Evaluar la capacidad institucional y analizar la incorporacion de los elementos de calidad de atencion en la estructura de las politicas y practicas institucionales en los servicios ambulatorios del Policlinico Nº 32 de la Caja Nacional de Salud de Cochabamba...

National Hospital Ambulatory Medical Care Survey: 2000 outpatient department summary.

OBJECTIVES: This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, clinic, patient, and visit characteristics. Highlights of trends in OPD utilization from 1997 through 2000 are also presented. METHODS: The data presented in this report were collected from the 2000 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates. Trends are based on NHAMCS data from 1997 through 2000. RESULTS: During 2000, an estimated 83.3 million visits were made to hospital OPDs in the United States, about 30.4 visits per 100 persons. Females had higher OPD visit rates than males (35.3 versus 25.2 visits per 100 persons). The OPD utilization rate for black persons was higher than for white persons (48.3 versus 28.0 visits per 100 persons). Of all visits made to hospital OPDs in 2000, private insurance (38.5 percent), Medicaid (22.1 percent), and Medicare (16.9 percent) were listed as the leading primary expected source of payment. Approximately 21 percent of OPD visits reported that patients belonged to an HMO. There were an estimated 9.5 million injury-related OPD visits in 2000. Since 1997, the percent of OPD visits that were for injuries increased by 24% (from 9.2 percent to 1.4 percent). Most of these visits were for unintentional injuries (57.6 percent), including those caused by falls (12.9 percent). Medications were prescribed at 64.0 percent of visits. On average, 1.6 medications were ordered at each OPD visit. In 2000, patients saw one or more physicians (i.e., staff physician, resident/intern, or other physician) at approximately 79 percent of visits. Most patients were given an appointment to return to the clinic (57.2 percent).

National Hospital Ambulatory Medical Care Survey: 1998 outpatient department summary.

OBJECTIVE: This report describes ambulatory care visits to hospital outpatient departments in the United States. Statistics are presented on selected hospital, clinic, patient, and visit characteristics. METHODS: The data presented in this report were collected from the 1998 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to hospital outpatient and emergency departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual estimates. RESULTS: During 1998, an estimated 75.4 million visits were made to hospital outpatient departments in the United States, an overall rate of 28.0 per 100 persons. Visit rates did not vary by age except in a comparison of the 15-24 year old group with the 75 years and over age group. Black persons had higher rates of visits than white persons as did women compared with men. Of all visits made to hospital outpatient departments in 1998, 33.8 percent and 25.9 percent, respectively, listed private insurance and Medicaid as the primary expected source of payment, and 21.9 percent were made by patients belonging to a health maintenance organization. There were an estimated 7.1 million injury-related outpatient department visits during 1998.

Depression in an elderly clinic population: findings from an ambulatory care setting.

Findings of a study of depression in an elderly hospital-based clinic population indicate that over 50% of older adults seen in specialty (psychiatric) clinics had a depressive diagnosis, but less than 2% of the elders seen in nonspecialty (medical) clinics were diagnosed with depression. Depressed patients in nonspecialty clinics had significantly more neurologic, respiratory and gastrointestinal comorbid conditions, nonpsychotropic medications, medical clinic visits, and medical hospitalizations than those elders treated for depression in the specialty clinic. Management of depression differed in type of provider and use of psychotherapy. However, there were no differences in the frequency, class, and specific type of psychotropic medications used in both clinic types.