Rosen A K, Houchens R L, Gibson T B, Mayer-Oakes A
Center for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Medical Center, Bedford, MA 01730, USA.
Am J Med Qual. 1998 Spring;13(1):25-35. doi: 10.1177/106286069801300104.
An episodes of care methodology examines the contiguous cluster of services related to a particular health condition. We developed an episodes methodology for evaluating the quality of health care delivery to privately insured adult asthma patients. Computer algorithms were used for episode construction beginning with an index asthma diagnosis and ending with a final clinical event, yielding a sample of 30,553 episodes. Only service claims with an asthma diagnosis were assigned to an episode. We used a database of private insurance claims from 1992 to 1993. Disease staging served as the framework for evaluating episodes with similar severity and resource use. We found that episodes of care can be constructed from claims data and have the potential for use in physician profiling and as quality screens. Certain limitations in using this methodology suggest that caution needs to be exercised in applying this approach to evaluation of health care services.
一种照护事件方法学审视了与特定健康状况相关的一系列连续服务。我们开发了一种事件方法学，用于评估为参加私人保险的成年哮喘患者提供的医疗服务质量。从哮喘诊断索引开始到最终临床事件结束，使用计算机算法构建事件，得到了30553个事件样本。只有诊断为哮喘的服务理赔才被纳入一个事件。我们使用了1992年至1993年的私人保险理赔数据库。疾病分期作为评估严重程度和资源使用相似的事件的框架。我们发现，可以从理赔数据构建照护事件，并且这些事件有潜力用于医生概况分析和作为质量筛选工具。使用这种方法存在某些局限性，这表明在将此方法应用于医疗服务评估时需要谨慎行事。
