RESUMEN

OBJECTIVE: Practice variations in the diagnosis, treatment, and outcomes of patients with major depression were examined within six psychiatric practices participating in a national outcomes-management project. METHODS: Six of 20 psychiatric clinics met selection criteria for this study and provided a database of 5, 106 patients. Patients completed the BASIS-32, the Short-Form-36 Health Survey, and a Beginning Services Survey. Treatment information was also obtained directly from the clinician or through a medical record review. RESULTS: Although 73.1 to 77 percent of patients screened positive for a depressive disorder, only 18.5 to 36.8 percent were diagnosed with major depression (p<.001). Between 39 and 72 percent of patients received psychotropic medications, a significant difference across sites (p<.001). In addition, the number of psychotherapy sessions was significantly different across sites (p<.001). CONCLUSIONS: Patient care varies considerably across psychiatric practices, a finding that is particularly relevant for developers of performance indicators and risk-adjustment strategies for mental health.

Asunto(s)

Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/terapia , Pautas de la Práctica en Medicina , Psiquiatría/tendencias , Psicotrópicos/uso terapéutico , Adulto , Áreas de Influencia de Salud , Trastorno Depresivo Mayor/epidemiología , Femenino , Humanos , Masculino , Servicios de Salud Mental/organización & administración , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Cooperación del Paciente , Psicoterapia/métodos , Encuestas y Cuestionarios , Resultado del Tratamiento , Estados Unidos

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 Unidos

RESUMEN

Self-esteem and value orientation are recognized in several theories as important factors in the development of delinquency. In a comparison of these theories, value orientation and different aspects of self-esteem were assessed using an individually administered test battery with male delinquents, marginal delinquents, and nondelinquents. No value orientation or overall self-esteem differences were found. The results are interpreted as generally supportive of the Kaplan theory, which holds that delinquents use psychological defenses to enhance their self-esteem and to retain endorsement of socially accepted values.