Perspective: Managed Care And Clinical Reality In Schizophrenia Treatment

Sharfstein, Steven S.; Boronow, John; Dickerson, Faith

doi:10.1377/hlthaff.18.5.66

Cited by 9 publications

(3 citation statements)

References 11 publications

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“…Shepard–Pratt, another private, nonprofit facility in Baltimore, reported that inpatient psychiatric LOS for adults and youths has declined substantially in the past decade, while admissions have risen dramatically. To provide continuity of care, Shepard–Pratt has contracted with outside agencies for outpatient services (Sharfstein, Boronow, & Dickerson, 2000). These strategies may signal emerging trends for hospitals under increasing financial pressures.…”

Section: Discussionmentioning

confidence: 99%

Changing patterns of inpatient care for children and adolescents at the Menninger Clinic, 1988–1994.

Pottick¹,

Barber²,

Hansell³

et al. 2001

Journal of Consulting and Clinical Psychology

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The authors describe trends in inpatient psychiatric length of stay (LOS) and admissions for the population of children and adolescents (N = 784) at the Menninger Clinic from 1988 to 1994. During this period. median LOS declined dramatically from 7 months to 3 weeks, whereas admissions increased 4-fold. The diagnostic case mix changed substantially, with a crossover in modal principal diagnosis from personality disorder to affective disorder. Use of medications became almost universal. Diagnosis and medication use became less important determinants of LOS over time. The practical implications of these patterns include higher patient turnover, fewer inpatient clinical contact hours, and heightened importance of continuity with outpatient care. Research should center on the impact of declining LOS on clinical and functional outcomes for children and adolescents.

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Section: Discussionmentioning

confidence: 99%

Changing patterns of inpatient care for children and adolescents at the Menninger Clinic, 1988–1994.

Pottick¹,

Barber²,

Hansell³

et al. 2001

Journal of Consulting and Clinical Psychology

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show abstract

“…Few studies have examined the impact of managed care on adherence with practice guidelines (Dickey et al, 2003;Kihlstrom, 1998;Sharfstein et al, 1999). One recent study showed that a major change in financing mental health services for Medicare and Medicaid recipients in Massachusetts had little impact on the quality of care for persons diagnosed with schizophrenia (Dickey et al, 2003).…”

mentioning

confidence: 99%

Adherence to Practice Guidelines, Clinical Outcomes, and Costs Among Medicaid Enrollees With Severe Mental Illnesses

Stiles¹,

Boothroyd²,

Dhont³

et al. 2009

Eval Health Prof

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The treatment of Medicaid enrollees diagnosed with depression or schizophrenia was examined to determine whether adherence to treatment guideline was associated with health care financing strategy, clinical outcomes, and cost-effectiveness. Individuals in a fee-for-service condition were significantly more likely to receive treatment consistent with guidelines than those in managed care. Mental health costs were higher for individuals diagnosed with schizophrenia, individuals in an acute phase of illness at intake into the study, and those receiving treatment consistent with practice guidelines. Being in an acute phase of illness and having treatment that comported with recommended practice guidelines were associated with higher total social costs. Policy implications of the findings and recommendations for future research are discussed.

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“…These individuals often rely on publicly funded health plans (i.e., Medicare and Medicaid), and publicly funded sources of care, including state hospitals, county hospitals, and local community mental health centers. Many people with schizophrenia in this country start with commercial private insurance and then shift to public-sector coverage (or no coverage at all) as their illness precludes continued employment to which most private insurance membership is tied (Sharfstein, Boronow, & Dickerson, 1999).…”

Section: Introductionmentioning

confidence: 99%

Determinants of Health Plan Membership Among Patients in Routine U.S. Psychiatric Practice

Compton

Weiss

Phillips

et al. 2006

Community Ment Health J

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This study utilized a large clinical dataset of patients representative of those in routine U.S. psychiatric practice to assess the influence of sociodemographic variables and diagnostic class on health plan membership (public or private). Data on patients with schizophrenia or other psychotic disorders (n=288) and patients with mood or anxiety disorders (n=1304) were obtained from a cross-sectional practice-based survey conducted by the American Psychiatric Institute for Research and Education. The likelihood of health plan membership was lower among males and among those from a minority race/ethnicity. Health plan membership was also affected by educational attainment and employment status. Even after controlling for these sociodemographic determinants of health plan membership, individuals with schizophrenia/other psychotic disorders were significantly less likely to belong to a health plan than those with mood/anxiety disorders.

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Perspective: Managed Care And Clinical Reality In Schizophrenia Treatment

Cited by 9 publications

References 11 publications

Changing patterns of inpatient care for children and adolescents at the Menninger Clinic, 1988–1994.

Changing patterns of inpatient care for children and adolescents at the Menninger Clinic, 1988–1994.

Adherence to Practice Guidelines, Clinical Outcomes, and Costs Among Medicaid Enrollees With Severe Mental Illnesses

Determinants of Health Plan Membership Among Patients in Routine U.S. Psychiatric Practice

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