Benefits and Constraints of Telepsychiatry and Rural Healthcare in the United States and West Virginia

About 60 million individuals, or 19.3% of the U.S population, lived in rural areas. Rural areas have encountered a higher than average shortage of mental health services, transportation, number of providers, poverty, and lack of insurance. The purpose of this research was to analyze the quality of care with the utilization of telemedicine in psychiatric care as well as its potential cost-saving benefits to both the payers and patients in the US and West Virginia. Tele psychiatric has been a successfully integrated program into psychiatric facilities reaching rural, prisons or city facilities based on that it has increased the volume of patients in which physicians can reach out to and diagnose, as well as treat patients with limitations in his or her mobility. Several studies have found that telepsychiatry has improved access and quality of care available in rural environments. Telepsychiatry can improve mental health outcomes by linking rural patients to Urban high-quality mental healthcare services that follow evidence-based care and best practices. The utilization of telemedicine in the field of psychiatry is believed to provide better access, quality and care to the patients who necessitate psychiatric care in their overall medical care

Cost of medical detoxification among drug and alcohol users in a private Texas hospital

Purpose – The purpose of this paper is to estimate the costs of medical detoxification among patients with alcohol and substance abuse disorders. Design/methodology/approach – The study data was drawn from a medical detoxification program in a community hospital in Texas. Secondary data analysis of 1337 cases from three years was reviewed. Age, gender, race, alcohol, cocaine, cannabis, amphetamines, sedatives, opioids, financial classification, cost, length of stay (LOS) and cost by LOS were analyzed using Kruskal-Wallis test and Mann-Whitney U-test. Findings – The sample comprised of 42.8 percent women and 57.2 percent males. The mean cost and cost by LOS was highest for cocaine ($2560.1 and$1,044, P\u3c0.01), while opioid and cannabis ($815.5, p\u3c0.01;$823.7, p\u3c0.01) had significantly higher values than the rest. In each individual drug detoxification class, except for amphetamines, the mean and median LOS has been reported to be less among the uninsured category compared to privately insured subjects. In addition, the cost by LOS was also found to be higher in the uninsured group compared to those with private insurance. Subjects who were uninsured and abused alcohol had higher median costs of detoxification (P\u3c0.01) by LOS. Research limitations/implications – Further in-depth analysis for confounding and interactions between variables is warranted. Originality/value – This research provides an estimation of LOS of a medical detoxification program by financial class in the USA and illustrates that early discharge of uninsured and Medicaid patients can be attributable to aggressive case management practices, interrupting the normal course of care

Hospital costs and clinical characteristics of continuous renal replacement therapy patients: A continuous ethical dilemma

This study describes the clinical characteristics and examines hospital costs involved in the care of 117 patients undergoing Continuous Renal Replacement Therapy (CRRT) between January 1999 and August 2002. The majority (70.9%) of the patients undergoing CRRT expired in the hospital. Statistically significant differences were found with respect to the length of stay for discharge status and gender; and with respect to costs for surgery versus no surgery and gender. Significant differences were also found between discharge status and gender, age, and cardiovascular surgery. The results of this study raise economic and ethical questions related to the cost/benefit of CRRT and the futility of the treatment. Hospitals should ensure that they have utilization protocols in place for CRRT, promote cooperation between intensive care unit (ICU) physicians and nephrologists, and create multi-disciplinary CRRT teams in an effort to maximize the effectiveness of therapy and minimize costs

School-Based Mental Health: A De Facto Mental Health System for Children

As the nation\u27s schools seek to fulfill the academic imperatives of the federal No Child Left Behind Act and associated state imperatives, they may be forgetting an important missing element in boosting academic achievement: directly confronting the mental health and psychosocial needs that impede a significant percentage of children and adolescents. This article explores the available research on mental health services in schools and the theoretical basis for multiple approaches to the problem. Creating a comprehensive solution to address mental and behavioral barriers to learning could significantly improve academic performance in U.S. primary and secondary schools

Computer physician order entry and clinical decision support systems: Benefits and concerns

Computerized Physician Order Entry has emerged as the greatest potential to decrease medications errors and improve efficiency. A literature review was conducted in systematic stages that included the research data from the last 25 years. Efficiencies were found with a decrease in overall workload of nurses, pharmacists and clerical workers. This led to decreased operating expenses. A secure way of transferring physician orders electronically will help hospitals and physicians practice a more efficient and higher quality of care in the US healthcare system

Accountable Care Organization Musical Chairs: Will There Be a Seat Remaining for the Small Group or Solo Practice?

When it was introduced in the Affordable Care Act of 2010 as the new 2012 payment model for Medicare, an accountable care organization (ACO) was a new and untested concept in healthcare delivery and payment. The authors estimated the likelihood of engagement in ACOs by small group and solo healthcare practitioners. An evaluation of five case studies showed that significant organizational, financial, and technological challenges had to be met in order to launch an ACO. Sufficient resources to meet those challenges were best supplied by large organizations. Small or solo practices participated only through varying levels of integration as salaried physicians or in independent practice associations or physician hospital organizations

Tweeting and Treating: How Hospitals Use Twitter to Improve Care

Introduction: Hospitals that have adopted Twitter primarily use it to share organizational news, provide general healthcare information, advertise upcoming community events, and foster networking. The purpose of this study was to explore the benefits that Twitter utilization has had in improving quality of care, access to care, patient satisfaction, and community footprint while assessing the barriers to its implementation. Methodology: The methodology used in this study was a qualitative study with a semi structure interview combined with a literature review which followed the basic principles of a systematic review. Results: The utilization of Twitter by hospitals suggest that it leads to savings of resources, enhanced employee and patient communication, and expanded patient reach in the community. Savings opportunities are generated by preventing unnecessary office visits, producing billable patient encounters, and eliminating high recruiting costs. Communication is enhanced using Twitter by sharing organizational content, news, and health promotions and can be also a useful tool during crises. Discussion: The utilization of Twitter in the hospital setting has been more beneficial than detrimental in its ability to generate opportunities for cost savings, recruiting, communication with employees and patients, and community reach

Expanding Technology in the ICU: The Case for the Utilization of Telemedicine

Introduction: Telemedicine has been utilized in various healthcare areas to achieve better patient outcomes, lower costs of providing services, and increase patient access to care. Tele-intensive care unit (ICU) technology has been introduced as a way to provide effective ICU services to patients with reduced access, as well as to decrease costs and improve patient care. Materials and Methods: The methodology for this qualitative study was a literature search and review of case studies. The search was limited to sources published in the last 10 years (2003–2013) in the English language. In total, 55 references were used for this research exploration inquiry. Results: Tele-ICU was found to be an effective way to use technology to decrease costs of providing intensive care, while improving patient outcomes such as mortality and length of stay. Several case studies supported the use of telemedicine in ICUs to provide intensive care to patients who lived in rural areas and lacked access to traditional ICUs. Furthermore, it was noted that, although the initial costs for tele-ICU startup were significant, as much as $100,000 per bed, the benefits of the utilization of this technology can offset those costs by reducing costs by 24% via decreased length of stay for patients. Conclusions: The findings of this study have suggested that the implementation of tele-ICU may have been more beneficial than costly, and it may have provided healthcare organizations the opportunity to increase quality of care and decrease mortality, while it might have decreased costs of delivering ICU services in both rural and urban areas

Financial incentives: Pay for performance (P4P) and the chronically ill patients

P4P is the reimbursement incentive that is based on quality improvement, efficiency, which is dominating the healthcare landscape and CMS. A literature review was conducted to search for and review significant information regarding P4P and how it pertains to chronic conditions and reimbursement methods. This literature review displayed while some programs were able to display a benefit/ profit for those involved such as insurance companies, hospitals, physicians and/or patients, most programs were unable to establish quality measures, cost effectiveness and positive program outcomes worth noting

Prenatal Opioid Maintenance in the U.S. and its Effect on Neo-Natal Abstinence Syndrome: The Case of West Virginia\u27s Opioid Epidemic

In 2017, West Virginia’s opioid epidemic was the cause of about 1000 deaths. Opioid abuse has become an issue among pregnant mothers and has increased the effects of Neonatal Abstinence Syndrome (NAS) in infants. The purpose of this study was to evaluate the participation of prenatal opioid maintenance to determine if it has decreased the amount of treatment needed for NAS in infants in West Virginia. The methodology utilized a literature review complemented with a semi-structured interview. Thirty-six sources were referenced for this literature review. It was found that Buprenorphine Maintenance Therapy had the most positive effect on NAS after birth. This review also reported a lack of availability for addicted pregnant women to enroll in maintenance programs and a high drop-out rate. Opioid maintenance therapy has permitted pregnant women to refrain from illicit drug use without experiencing withdrawal symptoms and it has allowed the opportunity for their infants to have better health after birth