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13. Assessing collaboration with mental health providers: the primary care perspective

Author

Gerdes, John L., Yuen, Elaine J., Wood, G. Craig, and Frey, Carolin M.

Abstract

Measuring the strength of collaborative relationships is necessary to assess the proposed association between primary care/ mental health collaboration and service outcomes in integrated health systems. Identifying the most salient [...]

Published
2001

24. Utilization of the office, hospital and emergency department for adult sickle cell patients: a five-year study

Author

Epstein, Kenneth, Yuen, Elaine, Riggio, Jeff M., Ballas, Samir K., and Moleski, Stephanie M.

Subjects
Adult, Male, Time Factors, New Jersey, Humans, Female, Anemia, Sickle Cell, Pennsylvania, Delaware, Emergency Service, Hospital, Hospitals, Physicians' Offices, Research Article
Abstract

Sickle cell disease (SCD) is a hematological disorder that is manifested primarily by severe pain and chronic organ damage. Little normative data exists on what the usual healthcare utilization is of a population of SCD patients, especially adults. Our study analyzed the office, emergency department (ED) and hospital use data for 142 patients who received care for three consecutive years. Relationships between health service use, patient age, gender and sickle cell phenotype were described. Multivariate analyses studied relationships between demographic and clinical characteristics and levels of office, independent ED and inpatient encounters over a five-year period (1997-2001). We found female patients were older and had less ED and hospital admissions. The 20% highest inpatient utilizers accounted for 54% of the ED total visits, 52% of the ED independent visits, 54% of hospital bed days and 24% of office visits. The ED was a common place for utilization, with a mean of 7.4 visits per patient year, a third of which resulted in a hospital admission. The healthcare utilization of our adult sickle cell population is very complex, with a subset of our patients accounting for a majority of the resources used and female patients living longer but with less ED and hospital admissions.

Published
2006

25. Prevalence, knowledge and care patterns for gastro-oesophageal reflux disease in United States minority populations.

Author

Yuen, Elaine, Romney, Martha, Toner, Richard W., Cobb, Nicole M., Katz, Philip O., Spodik, Maya, Goldfarb, Neil I., Yuen, Elaine, Romney, Martha, Toner, Richard W., Cobb, Nicole M., Katz, Philip O., Spodik, Maya, and Goldfarb, Neil I.

Abstract

BACKGROUND: While there is evidence of ethnic variation in the prevalence of gastro-oesophageal reflux disease (GERD) symptoms, few population-based studies examine GERD symptom prevalence amongst the growing Hispanic minority in the US as well as Asians in the West. AIM: To examine the prevalence, awareness and care patterns for GERD across different ethnic groups. METHODS: A population-based, cross-sectional survey was fielded in English, Chinese and Spanish that assessed self-reported GERD prevalence, awareness and care patterns in four ethnic groups (Caucasian, African American, Asian, Hispanic). RESULTS: A total of 1172 subjects were included for analysis: 34.6% experienced GERD symptoms at least monthly, 26.2% at least weekly and 8.2% at least daily. Statistically significant differences in raw prevalence rates between racial groups were found: 50% of Hispanics experienced heartburn at least monthly, compared with 37% of Caucasians, 31% of African Americans and 20% of Asians (P > 0.0001). Significant differences in knowledge and care-seeking patterns by ethnicity were also observed. CONCLUSIONS: This study confirms the high prevalence of GERD symptoms in the US and introduces Hispanics as the ethnicity with the highest prevalence rate. Asians in the US have higher rates of symptoms than in the Far East. These data demonstrate a need for culturally appropriate education about GERD symptoms and treatment.

Published
2010

38. Severity of illness and ambulatory care sensitive conditions

Author

Yuen, Elaine Jessie and Yuen, Elaine Jessie

Abstract

Purpose. This dissertation is a study of hospitalizations for two chronic health conditions, diabetes and asthma, chronic conditions (ambulatory care sensitive conditions or ACSCs) that with proper access to primary medical care can be well-managed in ambulatory settings. Hospitalization for these conditions may indicate problems or deficiencies in that care. The goal of this study is to describe factors and quantify costs that may be associated with these two ACSCs, as well as to discuss implications of these findings in planning and public health contexts. Methods. Geographically-based rates of hospitalization for diabetes and asthma, two ambulatory care sensitive conditions (ACSCs) are studied in relationship to access to care, population-based demographics, and hospital costs. Included in the ACSC definition is a severity of illness measure. Stratified rates as well as adjusted hospitalization rates are presented. Data from Pennsylvania Health Care Cost Containment Council, the Philadelphia Health Management Corporation, the Census, and the American Medical Association Physician Master-file was used. Results. Access to care was not found to be associated with rates of high severity ACSCs. Education was significantly associated with both high and low hospitalization severity ACSCs. These findings indicate that low severity (rather than high severity) ACSCs may be more sensitive to ambulatory care. GIS maps indicated a wide geographic ranges of hospitalization rates and cost per capita, even after adjusting for age, race, and gender; also showing is that asthma and diabetes are not solely problems of the inner city, urban areas. Conclusions. Populations at increased risk of receiving inadequate disease prevention and promotion services for asthma and diabetes have been identified through a refined measure of ACSCs by including dimensions of severity of illness. The applicability of this measure has the potential to be widespread and easily used to develop public p

Published
2000

49. Colorectal Cancer Is an Ambulatory Care Sensitive Condition.

Author

Sarfaty, Mona and Yuen, Elaine

Abstract

The article presents the author's view regarding Ambulatory Care Sensitive Conditions (ACSC). It states that ACSC are conditions wherein the probability of hospitalization might be affected by the ambulatory care provision. ACSC highlights continuum care for colorectal cancer, which include risk assessment, severity and stage of presentation, access to colonoscopy, and cost reduction.

Published
2008
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50. Impact of a DRG-based hospital financing system on quality and outcomes of care in Italy

Author

Louis, Daniel Z., Braga, Mario, Cicchetti, Americo, Rabinowitz, Carol, Laine, Christine, Gonnella, Joseph S., and Yuen, Elaine J.

Subjects
Medical care -- Quality management, Hospitals -- Finance, Health care reform -- Italy, Diagnosis related groups -- Research
Abstract

Objective. To examine potential changes in quality of care associated with a recent financing system implementation in Italy: in 1995, hospital financing reform implemented in Italy included the introduction of a DRG-based hospital financing system with the goals of controlling the growth of hospital costs and making hospitals more accountable for their productivity. Data Sources. Hospital discharge abstract data from 1993 through 1996 for all hospitals (N = 32) in the Friuli-Venezia-Giulia region of Italy. Regional population data were used to calculate rates. Study Design. Changes between 1993 and 1996 in hospital admissions, length of stay, mortality rates, severity of illness, and readmission rates were studied for nine common medical and surgical conditions: appendicitis, diabetes mellitus, colorectal cancer, cholecystitis, bronchitis/chronic obstructive pulmonary disease (COPD), bacterial pneumonia, coronary artery disease, cerebrovascular disease, and hip fracture. Principal Findings. The total number of ordinary hospital admissions decreased from 244,581 to 204,054 between 1993 and 1996, a population-based decrease of 17.3 percent (p [less than] .001). The mean length of stay decreased from 9.1 days to 8.8 days, resulting in a 21.1 percent decrease in hospital bed days (p [less than] .001). Day hospital use increased sevenfold from 16,871 encounters in 1993 to 108,517 encounters in 1996. The largest decrease in hospital admissions among study conditions was a 41 percent decrease for diabetes (from 2.25 per 1,000 in 1993 to 1.31 in 1996, p [less than] .001). For eight of the nine conditions, severity of illness increased. Differences between severity-adjusted expected and observed in-hospital mortality rates were small. Conclusions. Observed trends showed a decrease in ordinary hospital admissions, an increase in day hospital admissions, and a greater severity of illness among hospitalized patients. There was little or no change in mortality and readmission rates. Administrative data can be used to track changes in patterns of care and to identify potential quality problems deserving further review. Key Words. Italy, hospital financing, diagnosis-related groups (DRGs), quality of care, Disease Staging, The Italian Servizio Sanitario Nazionale (SSN) provides universal coverage for all 57 million citizens. The SSN, established in 1979, was modeled after the health care system in the United Kingdom [...]

Published
1999

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