Patient satisfaction with mental health services: a meta-analysis to establish norms

Patients typically express high rates of satisfaction with their mental health care. This finding and the lack of well controlled studies on patient satisfaction in the literature underscore the need for meaningful guidelines for clinicians and program evaluators in interpreting patient satisfaction data. To address this problem a meta-analysis was undertaken to establish norms on patient satisfaction for various types of mental health programs. Programs were categorized according to three dimensions: inpatient vs. outpatient vs. residential care; chronic vs. non-chronic; and conventional vs. innovative. Meta-analysis procedures were modified to accommodate the single-group study designs that dominate the literature. The analysis revealed that chronic patients express less satisfaction with their treatment compared to non-chronic patients. Innovative programs are viewed more positively than conventional ones. No differences were found in rates of patient satisfaction between inpatient and outpatient programs. Acceptably reliable norms and confidence intervals of patient satisfaction were established for conventional inpatient programs serving either chronic or non-chronic patients; conventional outpatient programs for non-chronic patients; and for all programs combined according to chronic vs. non-chronic, inpatient vs. outpatient, and conventional vs. innovative. However, data were insufficient to compute norms for other program types. The norms thus established can be used for comparative purposes by program evaluators. A cumulative, national data base on patient satisfaction is recommended to further refine these norms.     

Rebates, inventories, and intertemporal price discrimination

We demonstrate that universally redeemed rebates can increase manufacturer profits by reducing the incentives of downstream retailers to hoard inventories when optimal wholesale prices vary predictably over time. By bypassing retailers and making direct contracts with buyers, the manufacturer can increase the variations in effective prices paid by consumers without concomitantly creating larger incentives for retailers to hold inventories. During profitable, high-demand periods, manufacturer revenues are ordinarily constrained by'competition'from retailer inventories, thus limiting profits. However, by selectively offering rebates to consumers while maintaining high wholesale prices, low-demand periods can be accommodated without inducing retailer hoarding.     

Reliant behavior in the United States and Japan

Japanese economic success is often attributed to culturally reinforced psychological conditioning that promotes interpersonal reliance, cooperation, and a group interest orientation. This article provides direct experimental evidence on differences in behavior among future business people in the United States and Japan. Utilizing a simple, two person extensive form game of perfect information introduced by Selten (1975), we provide evidence that, contrary to some views, the Japanese can be less reliant on the behavior of others and are more likely to take actions at variance with group welfare in some settings. Thus, popular explanations of Japanese economic achievements may require further exploration.     

Using a NIATx based local learning collaborative for performance improvement

Local governments play an important role in improving substance abuse and mental health services. The structure of the local learning collaborative requires careful attention to old relationships and challenges local governmental leaders to help move participants from a competitive to collaborative environment. This study describes one county's experience applying the NIATx process improvement model via a local learning collaborative. Local substance abuse and mental health agencies participated in two local learning collaboratives designed to improve client retention in substance abuse treatment and client access to mental health services. Results of changes implemented at the provider level on access and retention are outlined. The process of implementing evidence-based practices by using the Plan-Do-Study-Act rapid-cycle change is a powerful combination for change at the local level. Key lessons include: creating a clear plan and shared vision, recognizing that one size does not fit all, using data can help fuel participant engagement, a long collaborative may benefit from breaking it into smaller segments, and paying providers to offset costs of participation enhances their engagement. The experience gained in Onondaga County, New York, offers insights that serve as a foundation for using the local learning collaborative in other community-based organizations.