Predisposing characteristics, enabling resources and need as predictors of utilization and clinical outcomes for veterans receiving mental health services.

Abstract:

BACKGROUND:Though demand for mental health services (MHS) among US veterans is increasing, MHS utilization per veteran is decreasing. With health and social service needs competing for limited resources, it is important to understand the association between patient factors, MHS utilization, and clinical outcomes. OBJECTIVES:We use a framework based on Andersen's behavioral model of health service utilization to examine predisposing characteristics, enabling resources, and clinical need as predictors of MHS utilization and clinical outcomes. METHODS:This was a prospective observational study of veterans receiving inpatient or outpatient MHS through Veterans Administration programs. Clinician ratings (Global Assessment of Functioning [GAF]) and self-report assessments (Behavior and Symptom Identification Scale-24) were completed for 421 veterans at enrollment and 3 months later. Linear and logistic regression analyses were conducted to examine: (1) predisposing characteristics, enabling resources, and need as predictors of MHS inpatient, residential, and outpatient utilization and (2) the association between individual characteristics, utilization, and clinical outcomes. RESULTS:Being older, female, having greater clinical need, lack of enabling resources (employment, stable housing, and social support), and easy access to treatment significantly predicted greater MHS utilization at 3-month follow-up. Less clinical need and no inpatient psychiatric hospitalization predicted better GAF and Behavior and Symptom Identification Scale-24 scores. White race and residential treatment also predicted better GAF scores. Neither enabling resources, nor number of outpatient mental health visits predicted clinical outcomes. CONCLUSIONS:This application of Andersen's behavioral model of health service utilization confirmed associations between some predisposing characteristics, need, and enabling resources on MHS utilization but only predisposing characteristics, need, and utilization were associated with clinical outcomes.

journal_name

Med Care

journal_title

Medical care

authors

Fasoli DR,Glickman ME,Eisen SV

doi

10.1097/mlr.0b013e3181cafbe3

subject

Has Abstract

pub_date

2010-04-01 00:00:00

pages

288-95

issue

4

eissn

0025-7079

issn

1537-1948

journal_volume

48

pub_type

杂志文章
  • The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence.

    abstract:OBJECTIVES:To help resolve the current controversy over the validity of early readmission as an indicator of the quality of care, the authors critically reviewed the literature using meta-analysis to derive summary estimates of effect and evaluate inter-study heterogeneity. METHODS:The authors selected reports meeting...

    journal_title:Medical care

    pub_type: 杂志文章,meta分析

    doi:10.1097/00005650-199710000-00006

    authors: Ashton CM,Del Junco DJ,Souchek J,Wray NP,Mansyur CL

    更新日期:1997-10-01 00:00:00

  • The last phase of life: who requests and who receives euthanasia or physician-assisted suicide?

    abstract:BACKGROUND:When suffering becomes unbearable for patients they might request for euthanasia. OBJECTIVE:To study which patients request for euthanasia and which requests actually resulted in euthanasia in relation with diagnosis, care setting at the end of life, and patient demographics. DESIGN:A cross-sectional study...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3181dbea75

    authors: Onwuteaka-Philipsen BD,Rurup ML,Pasman HR,van der Heide A

    更新日期:2010-07-01 00:00:00

  • A severity classification system for AIDS hospitalizations.

    abstract::The authors describe a new model for classifying hospitalized patients with acquired immunodeficiency syndrome (AIDS) according to their severity of illness. In the first phase of the project, a clinical model indicating the relative severity of AIDS complications was formulated, based on the clinical literature and e...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198904000-00009

    authors: Turner BJ,Kelly JV,Ball JK

    更新日期:1989-04-01 00:00:00

  • Physician's extenders' performance in Air Force clinics.

    abstract::We evaluated the quality of care of physician's extenders (PEs: 23 physician's assistants, 7 primary care nurse practitioners) in Air Force primary medicine clinics, as part of an evaluation of PEs' assuming a considerable portion of the care, formerly provided by physicians in the military medical system. Physician's...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198109000-00007

    authors: Goldberg GA,Jolly DM,Hosek S,Chu DS

    更新日期:1981-09-01 00:00:00

  • Psychosocial factors affecting adherence to medical regiments in a group of hemodialysis patients.

    abstract::The present research was designed to identify psychosocial correlates of adherence among patients receiving hemodialysis at two outpatient clinics. The 116 participants were interviewed concerning their knowledge of treatment, health beliefs, treatment history, social support, personal characteristics, and adherence t...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198206000-00003

    authors: Cummings KM,Becker MH,Kirscht JP,Levin NW

    更新日期:1982-06-01 00:00:00

  • Pharmacy-and diagnosis-based risk adjustment for children with Medicaid.

    abstract:BACKGROUND:Risk adjustment is useful for adjusting health care payments based on patients' health status. OBJECTIVE:This work seeks to examine how well pharmacy- and diagnosis-based risk adjusters predict child health expenditures in Medicaid populations. RESEARCH DESIGN:We used 1994-1995 Medicaid claims files for al...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000182551.87591.73

    authors: Kuhlthau K,Ferris TG,Davis RB,Perrin JM,Iezzoni LI

    更新日期:2005-11-01 00:00:00

  • A comparison of clinical performance of primary care and traditional internal medicine residents.

    abstract:OBJECTIVE:To compare primary care and traditional Internal Medicine residents in their adherence to preventive medicine guidelines, performance in the management of chronic diseases, and utilization of resources. DESIGN:Prospective cohort study. SETTING:Urban Internal Medicine residency program. PARTICIPANTS:Sixteen...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199908000-00007

    authors: Wong MD,Hollenberg JP,Charlson ME

    更新日期:1999-08-01 00:00:00

  • Children's health care and the changing role of women.

    abstract::The pivotal role of women as wife, mother or adult daughter in performing health-related activities for family members has received little attention from health researchers or policymakers. Yet the majority of health problems do not reach the medical care system, but are dealt with informally or through other social s...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198012000-00006

    authors: Carpenter ES

    更新日期:1980-12-01 00:00:00

  • A comparison of contract-managed and traditionally managed nonprofit hospitals.

    abstract::During the past five years, contract management of nonprofit hospitals by for-profit corporations has increased markedly. However, while a number of studies have been conducted on investor-owned hospitals and proprietary hospital systems, contract-managed hospitals have not been evaluated systematically. This paper re...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198006000-00002

    authors: Biggs EL,Kralewski JE,Brown GD

    更新日期:1980-06-01 00:00:00

  • Trends in mortality and medical spending in patients hospitalized for community-acquired pneumonia: 1993-2005.

    abstract:BACKGROUND:Community-acquired pneumonia (CAP) is the most common infectious cause of death in the United States. To understand the effect of efforts to improve quality and efficiency of care in CAP, we examined the trends in mortality and costs among hospitalized CAP patients. METHODS:Using the National Inpatient Samp...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3181f38006

    authors: Ruhnke GW,Coca-Perraillon M,Kitch BT,Cutler DM

    更新日期:2010-12-01 00:00:00

  • Consumer Use of Provider Quality Report Cards: The Role of Dissemination and Media Coverage.

    abstract:OBJECTIVE:The objective of this study was to measure the dissemination of comparative provider quality information (CPQI) and evaluate its impact on consumers' awareness and use of CPQI. DATA SOURCES:Two-period, random-digit-dial panel survey of chronically ill consumers residing in 14 regions of the United States; su...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001279

    authors: Bhandari N,Scanlon DP,Shi Y,Smith RA

    更新日期:2020-04-01 00:00:00

  • Association of physician specialty and medical therapy for benign prostatic hyperplasia.

    abstract:BACKGROUND:Despite little available evidence to determine whether recently introduced selective α-1 blockers and 5-α reductase inhibitors (5-ARIs) are superior to the existing agents in treating benign prostatic hyperplasia (BPH), they are being increasingly prescribed. OBJECTIVE:To describe the prescribing patterns o...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000078

    authors: Han LC,Kim SP,Gross CP,Ross JS,Van Houten HK,Smaldone MC,Krambeck AE,Shah ND

    更新日期:2014-02-01 00:00:00

  • Quality of acute episodic care in investor-owned ambulatory health centers.

    abstract::This article examines the quality of acute episodic care for five diagnostic categories amenable to one-visit diagnosis and treatment at the nation's largest chain of investor-owned ambulatory care centers. A total of 803 medical records were audited for five common conditions and measured against specific protocols. ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199101000-00007

    authors: Parks CL,Cashman S,Winickoff RN,Bicknell WJ

    更新日期:1991-01-01 00:00:00

  • Urgent care in the HMO: evolution of a system in Washington, D.C.

    abstract::In 1961, Group Health Association, a large, non-hospital based, prepaid group practice in Washington, D.C. established an after-hours walk-in clinic on its premises for the care of medical problems requiring prompt attention. Within a year, this clinic's operation was extended to daytime hours for the use of the consu...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-197805000-00001

    authors: Turner RW

    更新日期:1978-05-01 00:00:00

  • Comorbidity-adjusted complication risk: a new outcome quality measure.

    abstract::The measurement of inpatient complications his received substantial attention in recent years because mortality rates and other outcome measures often appear unable to discriminate superior from inferior hospital care. Complication measurement holds out the promise of being more sensitive to variations in patient care...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199605000-00010

    authors: Brailer DJ,Kroch E,Pauly MV,Huang J

    更新日期:1996-05-01 00:00:00

  • Healthcare task difficulty among older adults with multimorbidity.

    abstract:BACKGROUND:Applying disease-specific guidelines to people with multimorbidity may result in complex regimens that impose treatment burden. OBJECTIVES:To describe and validate a measure of healthcare task difficulty (HCTD) in a sample of older adults with multimorbidity. RESEARCH DESIGN:Cross-sectional and longitudina...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3182a977da

    authors: Boyd CM,Wolff JL,Giovannetti E,Reider L,Weiss C,Xue QL,Leff B,Boult C,Hughes T,Rand C

    更新日期:2014-03-01 00:00:00

  • Regression analysis in health services research: the use of dummy variables.

    abstract::Dummy variables frequently are used in regression analysis but often in an incorrect fashion. A brief review of examples in the medical care literature showed that the interpretation of dummy variable regression coefficients and their significance was often incorrect or unclear. This article shows how dummy variables ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198209000-00008

    authors: Polissar L,Diehr P

    更新日期:1982-09-01 00:00:00

  • Cesarean Delivery Rates and Costs of Childbirth in a State Medicaid Program After Implementation of a Blended Payment Policy.

    abstract:BACKGROUND:Nearly half of US births are financed by Medicaid, and one-third of births occur by cesarean delivery, at double the cost of vaginal delivery. With the goal of reducing unnecessary cesarean use and improving value, in 2009 Minnesota's Medicaid program introduced a blended payment rate for uncomplicated birth...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000937

    authors: Kozhimannil KB,Graves AJ,Ecklund AM,Shah N,Aggarwal R,Snowden JM

    更新日期:2018-08-01 00:00:00

  • Family structure and children's use of ambulatory physician services.

    abstract::The purpose of this article is to examine children's use of ambulatory physician services in relation to three dimensions of family life: maternal employment, single-parent versus two-parent households, and the presence of a nuclear or extended family. Data from the National Medical Care Expenditure Survey show that m...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198504000-00007

    authors: Cafferata GL,Kasper JD

    更新日期:1985-04-01 00:00:00

  • The SF-36 Health Survey as a generic outcome measure in clinical trials of patients with osteoarthritis and rheumatoid arthritis: tests of data quality, scaling assumptions and score reliability.

    abstract:OBJECTIVE:To evaluate the psychometric assumptions underlying the construction and scoring of SF-36 scales and summary measures among clinical trial participants with arthritis. METHODS:Cross-sectional SF-36 data from the baseline assessment of adult patients (n = 1,016) participating in four placebo-controlled clinic...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199905001-00002

    authors: Kosinski M,Keller SD,Hatoum HT,Kong SX,Ware JE Jr

    更新日期:1999-05-01 00:00:00

  • Predictors of aggressive therapy for nonmetastatic prostate carcinoma in Massachusetts from 1998 to 2002.

    abstract:BACKGROUND:Most studies have found that black men are less likely to receive aggressive therapy for nonmetastatic prostate cancer, even after controlling for covariates. However, previous studies have not accounted for the clustering of outcomes by facility. OBJECTIVE:We sought to compare the proportions of black and ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000257144.29928.f0

    authors: Rose AJ,Backus BM,Gershman ST,Santos P,Ash AS,Battaglia TA

    更新日期:2007-05-01 00:00:00

  • Predicting hospital utilization by the elderly. The importance of patient, physician, and hospital characteristics.

    abstract::This study developed an index of physician hospitalization practice style distinguishing physicians more prone to hospitalize patients from physicians less prone to hospitalize. The patients of physicians with markedly differing hospitalization styles are shown to be similar in such important characteristics as age, a...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198910000-00001

    authors: Roos NP

    更新日期:1989-10-01 00:00:00

  • Determinants of state variations in home health utilization and expenditures under Medicare.

    abstract::Of the key federal programs that finance in-home services to the elderly, the Medicare program represents the largest and fastest growing. Although Medicare is a federal program, utilization and expenditures for home care vary widely across the states. Building on the work of Feldstein, Scanlon, and others, theory and...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198606000-00008

    authors: Benjamin AE

    更新日期:1986-06-01 00:00:00

  • National trends in ethnic disparities in mental health care.

    abstract:OBJECTIVE:To compare trends in office-based treatment of mental disorders between Hispanics and non-Hispanics. DESIGN, SETTING, AND PARTICIPANTS:Analysis of a nationally representative sample of visits to office-based physicians conducted between 1993 and 2002 (N = 251,905). Visits were grouped into 3 discrete time pe...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3180ca95d3

    authors: Blanco C,Patel SR,Liu L,Jiang H,Lewis-Fernández R,Schmidt AB,Liebowitz MR,Olfson M

    更新日期:2007-11-01 00:00:00

  • Rates of complete colonic evaluation after incomplete colonoscopy and their associated factors: a population-based study.

    abstract:BACKGROUND:With the increasing use of colonoscopy there is growing concern about the quality of these procedures. OBJECTIVE:To evaluate the rates of complete colonic evaluation after an incomplete colonoscopy and their associated factors. METHODS:Men and women > or =50 years old living in Ontario on January 1, 1997 w...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e31817d92bc

    authors: Rizek R,Paszat LF,Stukel TA,Saskin R,Li C,Rabeneck L

    更新日期:2009-01-01 00:00:00

  • An introduction to multiple time series analysis.

    abstract::An expository account of multiple time series analysis is presented. Modeling several related time series together makes it possible to ascertain dynamic leading, lagging, and feedback relationships among the series; to produce more efficient forecasts and, in some situations; to develop control schemes. Procedures fo...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:

    authors: Tiao GC

    更新日期:1993-05-01 00:00:00

  • The impact of the SARS outbreak on an urban emergency department in Taiwan.

    abstract:OBJECTIVE:Emergency departments (ED) were on the front lines for possible cases of transmission during the severe acute respiratory syndrome (SARS) epidemic. The purpose of this study was to investigate the impact of the SARS catastrophe on an urban ED. METHODS:The patients' characteristics in an urban ED were collect...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200502000-00010

    authors: Chen WK,Cheng YC,Chung YT,Lin CC

    更新日期:2005-02-01 00:00:00

  • Comparing generic and disease-specific measures of physical and role functioning: results from the Veterans Health Study.

    abstract:OBJECTIVES:This study compared the performance of generic measures of Medical Outcome Study Short Form 36-Item Health Survey physical functioning and role limitations with disease-specific measures of physical functioning and role limitations using specific disease attributions for chronic lung disease, chronic low bac...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199802000-00005

    authors: Ren XS,Kazis L,Lee A,Miller DR,Clark JA,Skinner K,Rogers W

    更新日期:1998-02-01 00:00:00

  • Health care coverage and access to care: the status of Minnesota's veterans.

    abstract:OBJECTIVES:The primary objective of this study was to examine veterans' reliance on health care services provided by the Veterans Health Administration (VHA) within Minnesota and estimate the potential effect on uninsurance rates if all eligible veterans relied on VHA coverage. Secondary objectives were to compare vete...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000170403.97264.39

    authors: Jonk YC,Call KT,Cutting AH,O'Connor H,Bansiya V,Harrison K

    更新日期:2005-08-01 00:00:00

  • Using cognitive interviews to develop surveys in diverse populations.

    abstract:BACKGROUND:Conceptual equivalence of measures is essential in research that compares health across diverse racial/ethnic groups. Cognitive interviews are pretest methods to explore the conceptual equivalence of survey items. Systematic approaches for using these methods are emerging. OBJECTIVE:We describe an interacti...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000245425.65905.1d

    authors: Nápoles-Springer AM,Santoyo-Olsson J,O'Brien H,Stewart AL

    更新日期:2006-11-01 00:00:00