Kolb D S, Clay S B
Jennings Ryan & Kolb, Atlanta, GA.
J Ambul Care Manage. 1994 Jan;17(1):29-38. doi: 10.1097/00004479-199401000-00006.
This article explores case-mix adjustment systems in the ambulatory care environment as applied by managed care firms. An overview of ambulatory care groupings or ambulatory case-mix systems is given, and the special case-mix adjustment needs of managed care companies are reviewed. Generally, two types of ambulatory care grouping systems are available: encounter-based and population-based. Case examples of three managed care companies that are currently investigating the use of population-based case-mix systems are used to demonstrate the possible use of such systems in the managed care environment such as physician profiling and capitation rate setting.
本文探讨了管理式医疗公司在门诊医疗环境中应用的病例组合调整系统。文中给出了门诊医疗分组或门诊病例组合系统的概述，并审视了管理式医疗公司特殊的病例组合调整需求。一般来说，有两种类型的门诊医疗分组系统：基于诊疗人次的和基于人群的。文中使用了三家目前正在研究基于人群的病例组合系统应用的管理式医疗公司的案例，来展示此类系统在管理式医疗环境中的可能用途，如医生绩效评估和人头费率设定。
