Showing papers by "Robert A. Rosenheck published in 1991"

Involvement in an outreach and residential treatment program for homeless mentally ill veterans.

Abstract: Descriptive data derived from initial assessment interviews and from standardized 3-month progress reports are presented on 1684 homeless, chronically mentally ill veterans who were contacted at nine sites in a national Department of Veterans Affairs outreach program. Levels of involvement in the program were modest, with only 16% of those screened having over 10 clinical contacts and 24% still involved after 3 months. Demographic and clinical characteristics were weakly associated with continued involvement, but those admitted to residential treatment were 5.4 times more likely to be involved in the program than those not admitted. Admission to residential treatment appears to be the strongest determinant of clinical engagement of the homeless mentally ill.

Vietnam era and Vietnam combat veterans among the homeless.

Abstract: Of 10,524 homeless veterans assessed in a 43-site VA program, 50 percent served during the Vietnam War era, compared to only 29 percent of all veterans in the general population. This reflects the greater risk of homelessness among men aged 30-44 rather than the impact of Vietnam Era service. The proportion of homeless veterans who served in the Vietnam Theater (44.9 percent), and the proportion exposed to combat fire (40.5 percent) were similar to those of nonhomeless veterans. Homeless combat veterans who are not White were more likely to have psychiatric, alcohol, and medical problems than homeless noncombat Vietnam veterans who are not White.

Who is served by programs for the homeless? Admission to a domiciliary care program for homeless veterans.

Abstract: Demograpbic and dinical data are presented on 4,138 veterans assessedin the 20-site Department of Veterans Affairs (VA) Domiciliary Care for Homeless Veterans program during its first year of operation. More than two-thirds of the veterans who were screened had been hospitalized in VA medical centers during the year before assessment, and 34 percent were hospitalized at the time of assessment. Compared with veterans who were not admitted for residential treatment, veterans who were admitted were more likely to be previously involved in mental health treatment, literally homeless rather than at riskfor homelessness, and without publicfinancial support. Specialized service programs for the homeless such as the VA domiciliary care program may also be called on to play a broader role in the discharge and rehabilitative efforts of public mental health service systems.

Psychiatric inpatient care in the VA: before, during, and after DRG-based budgeting.

Abstract: OBJECTIVE The authors examined the impact of budgeting based on diagnosis-related groups (DRGs) on inpatient psychiatric care in Department of Veterans Affairs (VA) medical centers. DRG-based budgeting was implemented by the VA in 1984 and suspended in 1988. METHOD Computerized discharge abstracts were obtained for all episodes of VA inpatient care occurring from 1980 through 1989. The number of discharges per year, number of unduplicated patients treated, mean length of stay, total number of bed days of care per unique patient per year, readmission rates, and number of episodes of care per operational bed were determined for psychiatric and nonpsychiatric (medical-surgical) hospitalizations occurring before, during, and after DRG-based budgeting was in effect. RESULTS In the case of VA psychiatric care, DRG-based budgeting was associated with more episodes of care, shorter lengths of stay, higher readmission rates, and more episodes of care per occupied bed. DRG-based budgeting had similar effects on medical-surgical care, although an increase in the number of episodes of care was not observed. During the first year after this funding mechanism was suspended, changes in both psychiatric and medical-surgical care that were related to DRG-based budgeting were slowed and, in some cases, reversed. CONCLUSIONS Both psychiatric and medical-surgical inpatient care in the VA were sensitive to changes in funding mechanisms. These changes were generally similar to those observed in psychiatric care provided by non-VA hospitals reimbursed under Medicare's DRG-based prospective payment system.

and After DRG-Based Budgeting

Abstract: Objective: The authors examined the impact of budgeting based on diagnosis-related groups (DRGs) on inpatient psychiatric care in Department of Veterans Affairs (VA) medical centers. DRG-based budgeting was implemented by the VA in I 984 and suspended in 1988. Method: Computerized discharge abstracts were obtained for all episodes of VA inpatient care occurring from 1 980 through 1 989. The number of discharges per year, number of unduplicated patients treated, mean length of stay, total number of bed days of care per unique patient per year, readmission rates, and number of episodes of care per operational bed were determined for psychiatric and nonpsychiatric (medical-surgical) hospitalizations occurring before, during, and after DRG-based budgeting was in effect. Results: In the case of VA psychiatric care, DRG-based budgeting was associated with more episodes of care, shorter lengths ofstay, higher readmission rates, and more episodes ofcare per occupied bed. DRG-based budgeting had similar effects on medical-surgical care, although an increase in the number of episodes of care was not observed. During the first year after this funding mechanism was suspended, changes in both psychiatric and medical-surgical care that were related to DRG-based budgeting were slowed and, in some cases, reversed. Conclusions: Both psychiatric and medical-surgical inpatient care in the VA were sensitive to changes in f unding mechanisms. These changes were generally similar to those observed in psychiatric care provided by non-VA hospitals reimbursed under Medicare’s DRG-based prospective payment system.