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Constructing episodes of care from encounter and claims data: some methodological issues
T D Wingert1, J E Kralewski, T J Lindquist
1Institute for Health Services Research, University of Minnesota, Minneapolis 55455, USA.
Summary
Analyzing healthcare delivery using episodes of care is effective. A computerized method groups 31 major illnesses into five generic episode types for health maintenance organizations.
Area of Science:
- Health Services Research
- Health Informatics
Background:
- The episodes of care methodology is increasingly recognized for analyzing healthcare delivery.
- This approach organizes services around specific patient conditions or illnesses.
Purpose of the Study:
- To present a computerized method for developing episodes of care from encounter and claims data.
- To discuss methodological considerations in episode development.
- To categorize major illnesses into generic episode types.
Main Methods:
- Development of a computerized approach to define episodes of care.
- Analysis of encounter and claims data to identify patient care pathways.
- Grouping of 31 high-expense illnesses into five generic episode types.
Main Results:
- Successfully developed a computerized method for creating episodes of care.
- Identified five generic episode types encompassing 31 significant illnesses.
- Established specific criteria for defining these episodes of care.
Conclusions:
- The computerized episodes of care methodology is effective for analyzing healthcare delivery.
- This approach facilitates the organization and analysis of health services based on patient conditions.
- The identified generic episode types provide a framework for understanding and managing high-cost illnesses within health maintenance organizations.