Maureen Fahey

Acute hospital costs of trauma in the United States: implications for regionalized systems of care.

As part of a larger effort to determine total direct and indirect costs of injury in the United States, national estimates of the numbers and expenditures associated with acute hospitalization due to traumatic injury were derived using data from the 1984, 1985, and 1986 National Hospital Discharge Surveys (NHDS). Estimates of the numbers of hospital episodes and total expenditures are reported in this paper for subgroups of patients defined by age, sex, and body region and AIS severity of the injuries sustained. In 1985 2.1 million individuals sustained a traumatic injury which resulted in hospitalization. Hospital expenditures totaled

Creating the Web-based Intensive Care Unit Safety Reporting System

11.4 billion inclusive of professional fees. Adolescents and young adults aged 15-44 years accounted for nearly one half of all discharges and total hospital costs. The elderly, who represent only 12% of the population, accounted for an additional one quarter of total discharges and hospital costs. Nearly three quarters of the hospitalizations and one half of total expenditures were for minor (ICD/AIS = 1, 2) injuries. Moderate (ICD/AIS = 3) and severe (ICD/AIS = 4, 5), injuries respectively accounted for 23% and 3% of total episodes and 37% and 11% of total expenditures. Only 12% of patients and 25% of trauma care dollars involved injuries sufficiently severe to require treatment at a trauma center.(ABSTRACT TRUNCATED AT 250 WORDS)

Provider Continuity and Outcomes of Care for Persons with Schizophrenia

In an effort to improve patient safety, researchers at the Johns Hopkins University designed and implemented a comprehensive Web-based Intensive Care Unit Safety Reporting System (ICUSRS). The ICUSRS collects data about adverse events and near misses from all staff in the ICU. This report reflects data on 854 reports from 18 diverse ICUs across the United States. Reporting is voluntary, and data collected is confidential, with patient, provider, and reporter information deidentified. Preliminary data include system factors reported, degree of patient harm, reporting times, and evaluations of the system. Qualitative and quantitative data are reported back to the ICU site study teams and frontline staff through monthly reports, case discussions, and a quarterly newsletter.

Pattern of mortality in a sample of Maryland residents with severe mental illness

The study examines the relationship of provider continuity to outcomes of care (quality of life, payments for services) for Medicaid beneficiaries with schizophrenia. Data sources included Maryland Medicaid claims and enrollment data and in-person interviews. Measures of provider continuity over the year preceding the interview, calculated from claims for mental health ambulatory visits, were usual provider continuity (UPC—fraction of visits to the most frequently seen provider), sequential continuity (SECON—fraction of sequential visit pairs to the same provider), and continuity of care (COC—distribution of visits across different providers). Higher provider continuity was found to be related to lower costs and to lower likelihood of mental illness hospitalization. Provider continuity was not significantly related to general life satisfaction or to satisfaction with health. Persons with zero or one visit in a year (and for whom provider continuity could not be measured) had more severe depressive symptoms and were more likely to abuse substances but reported comparable satisfaction with health and overall quality of life while incurring lower Medicaid costs.

Antipsychotic Treatment Patterns and Hospitalizations Among Adults with Schizophrenia

In a cohort of Maryland Medicaid recipients with severe mental illness followed from 1993-2001, we compared mortality with rates in the Maryland general population including race and gender subgroups. Persons with severe mental illness died at a mean age of 51.8 years, with a standardized mortality ratio of 3.7 (95%CI, 3.6-3.7).

Met and Unmet Needs for Assistance and Quality of Life for People with Severe and Persistent Mental Disorders

OBJECTIVE(S) To characterize the longitudinal patterns of antipsychotic treatment and to investigate the relationship between antipsychotic treatment patterns and acute hospitalizations among adults with schizophrenia. We hypothesized that continuous antipsychotic treatment would be associated with fewer hospitalizations and shorter lengths of stay. METHOD Seven years of retrospective Maryland Medicaid administrative data were used to examine inpatient medical encounters and outpatient psychotropic treatment in community-based settings from 1993 through 2000. The sample consisted of 1727 adults continuously enrolled in the Maryland Medicaid program from July 1992 through June 1994, and diagnosed with schizophrenia. The main outcome measures were a) any schizophrenia hospitalization; b) number of schizophrenia hospitalizations; and c) inpatient days associated with a primary diagnosis of schizophrenia. RESULTS The average duration of antipsychotic use was six months in any single year and four and one-half years across the entire study period. Compared to individuals with a more continuous pattern of antipsychotic treatment, individuals with moderate or light use had odds of hospitalization for schizophrenia that were 52 or 72% greater (95%CI: 30-75% greater, 49-100% greater respectively). Light users of antipsychotics have an average length of stay per hospitalization that is approximately 20% longer than the average for continuous users (95%CI: 2-39% longer). CONCLUSIONS Findings emphasize the benefit of continuous antipsychotic treatment for individuals with schizophrenia.

Impact of hospital discharge planning on meeting patient needs after returning home.

People with severe mental illnesses often require help not only with managing their illness, but with a broad array of social and domestic activities. The impacts of the presence of such needs in several domains of function on quality of life ratings in the same domains are assessed using data from a survey of Maryland Medicaid recipients who have severe and persistent mental disorders. Measures included self-report of need and whether help was received for it, and Lehmans Quality of Life Interview. The presence of need was associated with lower quality of life ratings, and met needs improved those ratings relative to unmet need. A current diagnosis of depression resulted in lower quality of life, but successful treatment raised scores significantly. These findings underscore the potential impact the mental health service system can have on the quality of the lives of people it serves.