RESUMO
A fixed-prepayment system (case-based reimbursement) for patients initially requiring hospital-level care was evaluated for one year through an arrangement between a private nonprofit psychiatric hospital and a self-insured company desiring to provide psychiatric services to its employees. This clinical and financial experiment offered a means of containing costs while monitoring quality of care. A two-group, case-control study was undertaken of treatment outcomes at discharge, patient satisfaction with hospital care, and service use and costs during the program's first year. Compared with costs for patients in the control group, costs for those in the program were lower per patient and per admission; cumulative costs for patients requiring rehospitalization were also lower. However, costs for outpatient services for patients in the program were not calculated. Treatment outcomes and patients' satisfaction with hospital care were comparable for the two groups.
Assuntos
Hospitais Psiquiátricos/economia , Seguro Psiquiátrico/economia , Transtornos Mentais/reabilitação , Mecanismo de Reembolso/economia , Adolescente , Adulto , Serviços Contratados/economia , Feminino , Humanos , Tempo de Internação/economia , Masculino , Programas de Assistência Gerenciada/economia , Massachusetts , Transtornos Mentais/economia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Satisfação do Paciente , Resultado do TratamentoRESUMO
The Global Assessment Scale (GAS) is a comprehensive rating of psychiatric status that is usually based on face-to-face interviews. Validity has not been established for the use of the GAS when it is based on secondary sources of information about the patient, source of patient information, although secondary sources have been used for this purpose. The current study examined agreement between GAS ratings based on medical records and ratings based on face-to-face interviews. Results showed moderate agreement between the two sets of ratings, with the intraclass correlation-coefficient (ICC) equaling .62. Record-based (R)-GAS ratings were upwardly biased and were restricted in range when compared with interview-based (I)-GAS ratings. A case-by-case analysis showed that the disagreement could be accounted for by inconsistent documentation of the degree of functional impairment in the most severely disturbed patients. We conclude the following: If R-GAS ratings are used, designs should be modified to adjust for probable overestimated functioning of the most severely disturbed patients.