Kooperativer Bibliotheksverbund

Berlin Brandenburg

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  • 1
    In: Medical Care, 1988, Vol.26(11), pp.1092-1102
    Description: This study tested the hypothesis that increasing the intensity of outpatient care for patients discharged from the hospital could lower their subsequent inpatient and total health-care costs. At discharge, 1,001 patients were stratified by risk of readmission (low, medium, or high) and randomly assigned to the intervention or control group. Discharge information (summaries, medications, and postdischarge needs) was provided to outpatient nurses who monitored intervention patients closely and attempted to resolve their problems. Intervention patients also received appointment reminders, and missed visits were promptly rescheduled. The cost of the intervention was $5.20 per patient per month. High-risk patients in the intervention group had significantly higher outpatient costs ($131/month vs. $107/month; P=0.02), but lower inpatient costs ($535/month vs. $800/month; P=0.02) than high-risk patients in the control group. Reduced inpatient costs in the high-risk intervention group were attributed to shorter, less intensive hospital stays. In conclusion, increasing ambulatory care resources after hospital discharge for high-risk patients may reduce health-care costs associated with readmission to the hospital.
    Keywords: Medicine ; Public Health;
    ISSN: 0025-7079
    E-ISSN: 15371948
    Library Location Call Number Volume/Issue/Year Availability
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  • 2
    In: Medical Care, 1986, Vol.24(3), pp.189-199
    Description: Patients who fail to show for scheduled visits or who fail to contact their provider when warning symptoms occur pose important problems for the primary care physician. A group of interventions was examined to determine the effectiveness in increasing the number of prescribed office visits in patients with diabetes mellitus. This group of interventions included mailed packets with information on how to use the clinic, providersʼ names and phone numbers, after-hours phone numbers, a list of early warning signs, and a booklet on managing diabetes mellitus; mailed appointment reminders; and intense followup of visit failures for prompt rescheduling. Eight hundred fifty-nine patients on drug therapy for diabetes mellitus were stratified by risk of hospitalization and randomly assigned within strata to control and intervention groups. The intervention group received all interventions. After 1 year, the intervention group averaged 12% more total contacts than the control group (5.8 vs. 5.2, P = 0.01), due largely to an increase in kept scheduled visits (4.1 vs. 3.6, P = 0.006). These effects were greatest in those patients at higher risk of hospitalization. Also, visit failures were reduced only in high-risk patients. The effect of the interventions did not diminish during the year of study. This systematic and repetitive intervention appears effective in increasing prescribed office visits and is especially effective in patients requiring more frequent care.
    Keywords: Medicine ; Public Health;
    ISSN: 0025-7079
    E-ISSN: 15371948
    Library Location Call Number Volume/Issue/Year Availability
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