Browsing by keyword "*Continuity of Patient Care"
Now showing items 1-4 of 4
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Addressing the needs of youth in transition to adulthoodThe appalling young-adult outcomes of youth with serious emotional disturbance who are served in public systems demonstrate a failure of standard services to address the unique needs of these youths during their transition from adolescence to adulthood. This article discusses the needs of this population and the current ability of mental health and other relevant agencies to meet those needs. The contrast between needs and system status is presented through a framework of contrasting developmental and institutional transitions. This article reviews the barriers to effective system reform, and the recommendations for changes made by national panels focused on transition and applied research.
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Patient satisfaction and change in medical care provider: a longitudinal studyLongitudinal data from The Rand Corporation's Health Insurance Experiment were used to test the hypothesis that provider continuity can be modeled as one behavioral consequence of patient satisfaction. Bivariate and multivariate analyses (controlling for sociodemographic characteristics, prior use of services, health status, and health insurance plan) supported our hypotheses. A multivariate linear probability function indicated that a 1-point decrease on a general satisfaction scale was associated with a 3.4 percentage-point increase in the probability of provider change. The relationship between satisfaction scores and continuity during the following year appears to be roughly linear; we observed no "threshold" satisfaction level at which the probability of provider change increased markedly. We discuss needed improvements in the measurement of provider continuity and the need for further study of other behavioral consequences of patient satisfaction.
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Predictors of timely follow-up after abnormal cancer screening among women seeking care at urban community health centersBACKGROUND: We sought to measure time and identify predictors of timely follow-up among a cohort of racially/ethnically diverse inner city women with breast and cervical cancer screening abnormalities. METHODS: Eligible women had an abnormality detected on a mammogram or Papanicolaou (Pap) test between January 2004 and December 2005 in 1 of 6 community health centers in Boston, Massachusetts. Retrospective chart review allowed us to measure time to diagnostic resolution. We used Cox proportional hazards models to develop predictive models for timely resolution (defined as definitive diagnostic services completed within 180 days from index abnormality). RESULTS: Among 523 women with mammography abnormalities and 474 women with Pap test abnormalities, >90% achieved diagnostic resolution within 12 months. Median time to resolution was longer for Pap test than for mammography abnormalities (85 vs 27 days). Site of care, rather than any sociodemographic characteristic of individuals, including race/ethnicity, was the only significant predictor of timely follow-up for both mammogram and Pap test abnormalities. CONCLUSIONS: Site-specific community-based interventions may be the most effective interventions to reduce cancer health disparities when addressing the needs of underserved populations.
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Within-state availability of transition-to-adulthood services for youths with serious mental health conditionsOBJECTIVE: This study describes the existence and nature of services within state child and adult mental health systems that support the transition from adolescence to adulthood. METHODS: State child and adult mental health administrators from all but one state were interviewed by telephone with a semistructured questionnaire regarding transition services in their state mental health system, such as supported housing, vocational support, preparation for independent living, and dual diagnosis treatment. Eight states were deemed sufficiently decentralized to render state-level administrator reports invalid. Specific service data from the remaining 41 states and the District of Columbia were analyzed with descriptive statistics. RESULTS: One-quarter of child state mental health systems and one-half of adult state mental health systems offered no transition services, and few provided any kind of transition service at more than one site. Most types of transition services were available at all in less than 20 percent of the states. CONCLUSIONS: Across the United States transition support services are lacking. The adult system in particular will require major transformation to provide the service capacity that is needed to meet the current standards of transition service accessibility for young Americans with serious mental health conditions.