Does a dedicated discharge coordinator improve the quality of hospital discharge?
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OBJECTIVE: To evaluate the effectiveness of the role of a discharge coordinator whose sole responsibility was to plan and coordinate the discharge of patients from medical wards. DESIGN: An intervention study in which the quality of discharge planning was assessed before and after the introduction of a discharge coordinator. Patients were interviewed on the ward before discharge and seven to 10 days after being discharged home. SETTING: The three medical wards at the Homerton Hospital in Hackney, East London. PATIENTS: 600 randomly sampled adult patients admitted to the medical wards of the study hospital, who were resident in the district (but not in institutions), were under the care of physicians (excluding psychiatry), and were discharged home from one of the medical wards. The sampling was conducted in three study phases, over 18 months. INTERVENTIONS: Phase I comprised base line data collection; in phase II data were collected after the introduction of the district discharge planning policy and a discharge form (checklist) for all patients; in phase III data were collected after the introduction of the discharge coordinator. MAIN MEASURES: The quality and out come of discharge planning. Readmission rates, duration of stay, appropriateness of days of care, patients' health and satisfaction, problems after discharge, and receipt of services. RESULTS: The discharge coordinator resulted in an improved discharge planning process, and there was a reduction in problems experienced by patients after discharge, and in perceived need for medical and healthcare services. There was no evidence that the discharge coordinator resulted in a more timely or effective provision of community services after discharge, or that the appropriateness or efficiency of bed use was improved. CONCLUSIONS: The introduction of a discharge coordinator improved the quality of discharge planning, but at additional cost. (+info)
Improving access to disability benefits among homeless persons with mental illness: an agency-specific approach to services integration.
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OBJECTIVES: This study evaluated a joint initiative of the Social Security Administration (SSA) and the Department of Veterans Affairs (VA) to improve access to Social Security disability benefits among homeless veterans with mental illness. METHODS: Social Security personnel were colocated with VA clinical staff at 4 of the VA's Health Care for Homeless Veterans (HCHV) programs. Intake assessment data were merged with SSA administrative data to determine the proportion of veterans who filed applications and who received disability awards at the 4 SSA-VA Joint Outreach Initiative sites (n = 6709) and at 34 comparison HCHV sites (n = 27 722) during the 2 years before and after implementation of the program. RESULTS: During the 2 years after the initiative began, higher proportions of veterans applied for disability (18.9% vs 11.1%; P < .001) and were awarded benefits (11.4% vs 7.2%, P < .001) at SSA-VA Joint Initiative sites. CONCLUSION: A colocation approach to service system integration can improve access to disability entitlements among homeless persons with mental illness. Almost twice as many veterans were eligible for this entitlement as received it through a standard outreach program. (+info)
Ethnic groups and our healthier nation: whither the information base?
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The Government has made the health of minority ethnic groups a central part of its programme to reduce social exclusion and inequalities in health provision. It has also given a commitment in its 'contract for health' to provide the information that is needed to address inequalities, stating that it will be able to draw on a range of data sources, including mortality statistics, cancer registrations, hospital episode data, and general practitioner data. In reality, only one of these is a potential source of comprehensive information on minority ethnic groups and the information base needed to support Government policies is essentially unavailable. Priorities for further action are identified. (+info)
A survey of social services needs assessments for elderly mentally ill people in England and Wales.
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OBJECTIVE: to examine variations in the needs assessment policies and practices of social services departments in England and Wales in dealing with elderly people who have mental illness. DESIGN: postal questionnaire survey. SUBJECTS: a random sample of 61 of 119 social services departments in England and Wales. MAIN OUTCOME MEASURE: 99-item questionnaire. RESULTS: 40 responses were received (66%). There were substantial differences in the way referrals were screened before needs assessment and in the design of needs assessment procedures. Disagreements between health and social services were common and, although mechanisms existed to respond to urgent needs, almost one-third found such responses difficult to make. CONCLUSIONS: there are national variations in the way needs assessments are performed by social services, which may lead to inequalities in provision of care to individuals. The lack of a standardized approach impedes comparisons of need between areas which might aid in the distribution of resources at a national level. (+info)
Randomised studies of income supplementation: a lost opportunity to assess health outcomes.
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BACKGROUND: Despite the wealth of evidence linking low income to ill health, there is little information from randomised studies on how much and how quickly these risks can be reversed by improvements in income. OBJECTIVE: To conduct a systematic review of randomised studies of income supplementation, with particular reference to health outcomes. DESIGN: Extensive searches of electronic databases and contact with previous authors. As well as searching for trials that were specifically designed to assess the effects of increased income, studies of winners and losers of lotteries were also sought: if winning is purely chance, such studies are, in effect, randomised trials of increased income. RESULTS: Ten relevant studies were identified, all conducted in North America, mostly in the late 1960s and 1970s. Five trials were designed to assess the effects of income supplementation on workforce participation and randomised a total of 10,000 families to 3-5 years of various combinations of minimum income guarantees and reduced tax rates. Two trials were designed to assess re-offending rates in recently released prisoners and randomised a total of 2400 people to 3-6 months of benefits. One trial was designed to assess housing allowances and randomised 3500 families to three years of income supplements. One trial assessed the health effects of 12 months of income supplementation in 54 people with severe mental illness. Finally, one study compared three groups of people who won different amounts of money in a state lottery. In all these studies the interventions resulted in increases in income of at least one fifth. However, no reliable analyses of health outcome data are available. CONCLUSIONS: Extensive opportunities to reliably assess the effects of increases in income on health outcomes have been missed. Such evidence might have increased the consideration of potential health effects during deliberations about policies that have major implications for income, such as taxation rates, benefit policies, and minimum wage levels. Randomised evidence could still be obtained with innovative new studies, such as trials of full benefit uptake or prospective studies of lottery winners in which different sized winnings are paid in monthly installments over many years. (+info)
Do multi-sectoral development programmes affect health? A Bolivian case study.
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This cross-sectional study, carried out in Inquisivi, Bolivia, a rural area where Save the Children/US works, tests the hypothesis that participation in multisectoral development programmes results in improved health behaviours and better health outcomes. To test this hypothesis, four groups of households were compared: those participating in Save the Children's health-only programmes; those with access to health and micro-enterprise credit or health and literacy programmes; those participating in all three programmes (health, credit and literacy); and households from comparison communities (no access to any of Save the Children's programmes). Data come from a stratified sample of 499 households in the altiplano, foothills and valleys of the Andes. Findings reported here suggest that there is no clear association between participation in one or more of Save the Children's programmes and parents' actions to prevent and treat diarrhoea. Additionally, the point prevalence of diarrhoea was similar for all four groups. However, children of individuals participating in health, credit and literacy were significantly less likely than children from comparison communities to be malnourished or at risk of becoming malnourished, even after controlling for such potentially confounding factors as social class, source of drinking water, and the availability of health facilities. (+info)
Medical and psychosocial services in drug abuse treatment: do stronger linkages promote client utilization?
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OBJECTIVE: To examine the extent to which linkage mechanisms (on-site delivery, external arrangements, case management, and transportation assistance) are associated with increased utilization of medical and psychosocial services in outpatient drug abuse treatment units. DATA SOURCES: Survey of administrative directors and clinical supervisors from a nationally representative sample of 597 outpatient drug abuse treatment units in 1995. STUDY DESIGN: We generated separate two-stage multivariate generalized linear models to evaluate the correlation of on-site service delivery, formal external arrangements (joint program/venture or contract), referral agreements, case management, and transportation with the percentage of clients reported to have utilized eight services: physical examinations, routine medical care, tuberculosis screening, HIV treatment, mental health care, employment counseling, housing assistance, and financial counseling services. PRINCIPAL FINDINGS: On-site service delivery and transportation assistance were significantly associated with higher levels of client utilization of ancillary services. Referral agreements and formal external arrangements had no detectable relationship to most service utilization. On-site case management was related to increased clients' use of routine medical care, financial counseling, and housing assistance, but off-site case management was not correlated with utilization of most services. CONCLUSIONS: On-site service delivery appears to be the most reliable mechanism to link drug abuse treatment clients to ancillary services, while referral agreements and formal external mechanisms offer little detectable advantage over ad hoc referral. On-site case management might facilitate utilization of some services, but transportation seems a more important linkage mechanism overall. These findings imply that initiatives and policies to promote linkage of such clients to medical and psychosocial services should emphasize on-site service delivery, transportation and, for some services, on-site case management. (+info)
Problems of an aging population in an era of technology.
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With the substantially growing number of elderly persons in Canada and the rest of the developed world, the need for adequate health and social care will increase. Health and social service providers must develop policies and programs allowing the elderly to lead rich and independent lives for as long as possible. As advances in age-related diseases are made, the elderly will potentially live longer and lead more active and fulfilling lives. Society, governments and those involved in the care of the elderly must meet the new challenges of this aging population in a humane and respectful way. (+info)