The conversion of claims files to an episode data base: a tool for management and research

The construction of an episode-of-care file based on utilization data from the insurance claims system of Blue Cross and Blue Shield of North Carolina was undertaken for its subscribers and Medicare beneficiaries, a data base that includes 60% of the hospital days in North Carolina. The conversion was accomplished without interfering with the integrity of the accounting system, and the resulting file provides essential data for management decisions and epidemiological research. Among the uses to which the information in the file can be put are the promotion of ambulatory surgery, the redesign of group insurance benefits by employers, and the support of statewide health planning programs.