Mehta S S, Suzuki S, Glick H A, Schulman K A
Clinical Economics Research Unit, Georgetown University Medical Center, Washington, DC 20007, USA.
Diabetes Care. 1999 Jul;22(7):1110-5. doi: 10.2337/diacare.22.7.1110.
Amid changes in the organization and financing of health care, health care decision makers are increasingly interested in episodes of care. We sought to determine an episode of care for diabetic foot ulcer using an administrative claims database.
We used 1993-1995 claims data to assess resource utilization for privately insured patients with diabetic foot ulcers. Over a 26-week period, we determined the episode length by comparing differences in average daily charges and proportion of patients with charges before and after foot ulcer diagnosis. All 13 weeks before diagnosis were used to calculate baseline values. Significance was determined by CIs, which were calculated by a nonparametric bootstrap technique. Costs associated with the episode were also calculated. A sensitivity analysis using weeks with highest and lowest values as baseline was also conducted.
Based on average daily charges, the episode of care for diabetic foot ulcer was 5 weeks. Using proportion of patients with charges, the episode was longer than 13 weeks. The cost for an episode of care ranged from $900 to $2,600. In the sensitivity analyses, episodes of care ranged from 1 to 13 weeks.
Episodes of care can be defined by the period beginning with increased resource consumption and ending when resource consumption returns to baseline levels. With the growth of managed care and disease management programs, episode-of-care analysis may have an increasingly important role in health care provision and delivery.
在医疗保健的组织和融资发生变化的情况下，医疗保健决策者对医疗服务事件越来越感兴趣。我们试图使用行政索赔数据库来确定糖尿病足溃疡的一个医疗服务事件。
我们使用1993 - 1995年的索赔数据来评估患有糖尿病足溃疡的私人保险患者的资源利用情况。在26周的时间里，我们通过比较足部溃疡诊断前后平均每日费用的差异以及有费用支出的患者比例来确定事件时长。诊断前的所有13周用于计算基线值。显著性通过置信区间确定，置信区间采用非参数自助法计算。还计算了与该事件相关的费用。还进行了一项敏感性分析，将最高值和最低值的周数作为基线。
基于平均每日费用，糖尿病足溃疡的医疗服务事件为5周。使用有费用支出的患者比例来计算，该事件时长超过13周。一个医疗服务事件的费用在900美元至2600美元之间。在敏感性分析中，医疗服务事件时长在1周至13周之间。
医疗服务事件可以定义为从资源消耗增加开始到资源消耗恢复到基线水平结束的时间段。随着管理式医疗和疾病管理项目的发展，医疗服务事件分析在医疗保健的提供和交付中可能会发挥越来越重要的作用。
