RESUMEN
Provider organizations are under increased pressure from payors to produce outcomes data that demonstrate the effectiveness of their treatment services. More and more, providers are collaborating on joint outcomes projects that allow them to benchmark their results with similar organizations. Here are five brief descriptions of such projects. They span a wide spectrum of organizations and include hospitals and comprehensive healthcare systems, behavioral group practices, child welfare agencies, and psychosocial rehabilitation programs. Part one begins below, part two, on page 45.
Asunto(s)
Bases de Datos Factuales , Servicios de Salud Mental/normas , Evaluación de Resultado en la Atención de Salud , Acreditación , Centers for Medicare and Medicaid Services, U.S. , Niño , Protección a la Infancia , Análisis Costo-Beneficio , Eficiencia Organizacional , Práctica de Grupo/organización & administración , Práctica de Grupo/normas , Sistemas Prepagos de Salud/organización & administración , Investigación sobre Servicios de Salud , Humanos , Joint Commission on Accreditation of Healthcare Organizations , Trastornos Mentales/rehabilitación , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Responsabilidad Social , Estados UnidosAsunto(s)
Eficiencia Organizacional , Guías como Asunto , Servicios de Salud Mental/normas , Evaluación de Resultado en la Atención de Salud/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Prestación Integrada de Atención de Salud/normas , Innovación Organizacional , Técnicas de Planificación , Estados UnidosRESUMEN
Outcomes measurement and data-triggered improvements in treatment delivery are formidable challenges, in part because of their inherent interdependence. Outcomes systems need to provide reliable, valid and comparable data that can also guide transitions in care delivery. While there is much empirical support for the efficacy of psychiatric and behavioral healthcare interventions, it is incumbent upon those who know both the literature and clinical practice to participate in setting the future course of behavioral healthcare by stirring together the seemingly immiscible aims of good business and good care. This paper briefly reviews the importance of outcomes measurement systems and their use in redesigning treatment delivery in behavioral healthcare. It then describes a clinical care model now being implemented at Park Nicollet Medical Center, incorporating clinical and operational considerations, clinical outcomes measures and algorithms or decision trees into a framework for redesigning treatment and improving the delivery of appropriate clinical care.
Asunto(s)
Modelos Organizacionales , Evaluación de Resultado en la Atención de Salud/organización & administración , Servicio de Psiquiatría en Hospital/normas , Reestructuración Hospitalaria , Minnesota , Innovación Organizacional , Planificación de Atención al Paciente , Atención Progresiva al Paciente , Servicio de Psiquiatría en Hospital/organización & administraciónAsunto(s)
Depresión/psicología , Adulto , Depresión/diagnóstico , Femenino , Humanos , Masculino , Factores SexualesRESUMEN
Eight hyperactive children were treated with a behavioral intervention focusing on teacher and parent training over a period of 5 months. Three times, before therapy and after 3 weeks and 13 weeks of intervention, children received methylphenidate during 3-week probe periods. Each week in a probe they received either a placebo, .25 mg/kg, or .75 mg/kg methylphenidate. Classroom observation of on-task behavior suggested that effectiveness of the behavioral intervention was between that of the two dosages of medication before therapy. Both dosages resulted in higher levels of on-task behavior when administered after 13 weeks of behavioral intervention than when administered before therapy. Teacher rating data showed equivalent effects of therapy and the low dosage of methylphenidate alone but a stronger effect of the high dose alone; only the high dose resulted in improved behavior after 13 weeks of behavioral intervention. As a group, only when they received the high dose of methylphenidate after 13 weeks of behavioral intervention did children reach the level of appropriate behavior shown by nonhyperactive controls. However, this level was also reached by two children with the low dose and by one child without medication, and it was not reached by one child. The results suggest that the combination of psychostimulant medication and behavior therapy may be more effective in the short-term than either treatment alone for hyperactive children in school settings. In addition, parent ratings and clinic observation of parent-child interactions suggested that children had improved in the home setting, high-lighting the importance of behavioral parent training in the treatment of hyperactivity.