Health Care Episodes: Definition, Measurement and Use

Hornbrook, Mark C.; Hurtado, Arnold V.; Johnson, Richard E.

doi:10.1177/107755878504200202

Cited by 153 publications

(74 citation statements)

References 18 publications

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“…48 As demonstrated by data synthesized by Elton (Figure 1), individuals with similar risk profiles who begin their care pathway with a chiropractor or PCP see fewer total health care providers throughout the overall episode of care than do individuals 392 KOSLOFF ET AL.…”

Section: Current Clinical Practicesmentioning

confidence: 99%

Conservative Spine Care: Opportunities to Improve the Quality and Value of Care

Kosloff

Elton

Shulman

et al. 2013

Population Health Management

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Low back pain (LBP) has received considerable attention from researchers and health care systems because of its substantial personal, social, work-related, and economic consequences. A narrative review was conducted summarizing data about the epidemiology, care seeking, and utilization patterns for LBP in the adult US population. Recommendations from a consensus of clinical practice guidelines were compared to findings about the current state of clinical practice for LBP. The impact of the first provider consulted on the quality and value of care was analyzed longitudinally across the continuum of episodes of care. The review concludes with a description of recently published evidence that has demonstrated that favorable health and economic outcomes can be achieved by incorporating evidence-informed decision criteria and guidance about entry into conservative low back care pathways. (Population Health Management 2013;16:390-396)

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Section: Current Clinical Practicesmentioning

confidence: 99%

Conservative Spine Care: Opportunities to Improve the Quality and Value of Care

Kosloff

Elton

Shulman

et al. 2013

Population Health Management

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“…In the medical home model, care is provided by a dedicated team of providers, and they are reimbursed with an upfront fee and higher reimbursement for episodes of care (15). An episode of care is a managed care concept in which a single payment for health care services is provided for a specifi c illness during a set time period (16). Th e National Committee for Quality Assurance (NCQA) developed the standards for the primary care PCMH program (17).…”

Section: Discussionmentioning

confidence: 99%

Model for the Cost-Efficient Delivery of Continuous Quality Cancer Care: A Hospital and Private-Practice Collaboration

Coyle¹,

Miller²,

Paulson³

2013

Baylor University Medical Center Proceedings

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Proc (Bayl Univ Med Cent) 2013;26(2):95-99Cancer care is expensive due to the high costs of treatment and preventable utilization of resources. Government, employer groups, and insurers are seeking cancer care delivery models that promote both cost-efficiency and quality care. Baylor University Medical Center at Dallas (BUMC), a large tertiary care hospital, in collaboration with Texas Oncology, a large private oncology practice, established two independent centers that function cooperatively within the Baylor Charles A. Sammons Cancer Center, the Oncology Evaluation and Treatment Center (OETC) and Infusion Center, to deliver urgent care and infusions after hours to oncology patients. Quality measures based on evidence-based care and cost-efficiency measures were implemented within these centers. Ability to meet predetermined goals for these measures will be a guide for implementing continuous quality and cost-efficiency interventions. During the first two quarters of operations, 2023 patients received care in the OETC (n = 423) and Infusion Center (n = 1600). The average time spent in the OETC was 48% less than the time spent in the BUMC emergency department (ED). Eighty-nine percent of the cancer center's patients who received urgent care at BUMC were referred to the OETC for this care, instead of the BUMC ED. The hospital admission rate in the OETC was 59% lower than it was in the BUMC ED, a high-volume level I trauma center. The addition of the OETC and Infusion Center to the cancer center holds promise for providing continuous quality cancer care that is cost-efficient.

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“…The concept of episode of care has been elaborated in order to deal with output and outcome comparison, and it has led to the development of some classification schemes and commercial software [1][2][3]. However, these systems require clinical data of a quality not common in Europe.…”

Section: Risk-adjusted Models Of Costs Referable To General Practitiomentioning

confidence: 99%

Risk-Adjusted Models of Costs Referable to General Practitioners Based on Administrative Databases in the Friuli Venezia Giulia Region in Northern Italy

Piergentili¹,

Simon²,

Paccagnella³

et al. 2015

Arch Community Med Public Health

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Objective: To develop risk adjustment models for cost evaluation in primary health care in Italy based on administrative databases. Setting:The 2007 administrative databases from the National Health Service of the Friuli Venezia Giulia Region were the data source. Data referred to the general population and included information on the use of health services (inpatient, outpatient, medication, home care) as well as on the major chronic health problems. Data included persons who, for their health condition, must not pay the contribution usually required for using health services (ticket exemption).Design: Multilevel (multivariate) statistical analysis, where the tariff of services or the price of drugs (both summed up and separated) were the dependent variables, and the health conditions and other variables related to the citizens were the predictive variables. Results:The analysis included 1,067,239 citizens registered with a General Practitioner (GP) and 1,129 GPs. The number of people with at least one ticket exemption was 461,532. A number of predictive models were developed, which considered the sum of all tariffs and prices, tariffs and prices of inpatient and outpatient services, and medications. The models had very robust results. The models explained a considerable share of the variation using the (R 2 1 ) parameter: the proportional reduction of error for predicting the level-1 dependent variable with respect to the model without any predictors. The R 2 1 was 44.6% for the sum of tariffs and expenditures, 30.9% for hospital tariffs, 27.1% for inpatient services and 49.3% for medications. The intra class correlation coefficient (ICC), which measures the proportion of residual variability due to the second level of analysis (GP), shows that, controlling for the Casemix, the amount of the residual variability driven by the GPs is very low or even negligible: 0.89% for total individual health care tariffs, <0.1% for inpatient services, 1.49% for outpatients services, and 2.0% for drug prescriptions. Discussion:The health status information provided by the ticket exemption database proved to be valid beyond the Researchers expectations, despite known data quality problems. The large study sample size may have played a role in these results. Primary health care risk adjustment can be performed using administrative databases instead of GP clinical records, making it much easier and less costly. The overall variation explained by the models was in line with the findings in the literature. The residual variation attributable to GPs was unexpectedly low. In the inpatient setting, this may be partly due to a systemic effort to reduce inappropriate hospitalisation. In the other settings this result came as a surprise, and may lead to a reconsideration of GP behaviour variation. Outcome and output measures in PHC without proper risk adjustment may lead to inaccurate findings.PHC in order to evaluate quality of care and cost containment on a systemic scale. In fact, hospital care can be viewed as part of the c...

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Health Care Episodes: Definition, Measurement and Use

Cited by 153 publications

References 18 publications

Conservative Spine Care: Opportunities to Improve the Quality and Value of Care

Conservative Spine Care: Opportunities to Improve the Quality and Value of Care

Model for the Cost-Efficient Delivery of Continuous Quality Cancer Care: A Hospital and Private-Practice Collaboration

Risk-Adjusted Models of Costs Referable to General Practitioners Based on Administrative Databases in the Friuli Venezia Giulia Region in Northern Italy

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