Developing Episodes of Care for Adult Asthma Patients: A Cautionary Tale

American Journal of Medical Quality

Volumn 13, Issue 1, 1998, Pages 25-35

  Rosen, Amy K ^a   Houchens, Robert L ^b   Gibson, Teresa B ^b   Mayer Oakes, Allison ^c  

^a VETERANS AFFAIRS MEDICAL CENTER   (United States)

^b MEDSTAT GROUP   (United States)

^c Sansum Clinic   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ALGORITHM; ARTICLE; ASTHMA; FACTUAL DATABASE; FEMALE; HEALTH CARE QUALITY; HEALTH SERVICES RESEARCH; HUMAN; INSURANCE; MALE; METHODOLOGY; MIDDLE AGED; OUTCOME ASSESSMENT; PATIENT CARE; RISK FACTOR; UNITED STATES;

ADULT; ALGORITHMS; ASTHMA; DATABASES, FACTUAL; EPISODE OF CARE; FEMALE; HEALTH SERVICES RESEARCH; HUMANS; INSURANCE CLAIM REPORTING; MALE; MIDDLE AGED; OUTCOME ASSESSMENT (HEALTH CARE); QUALITY OF HEALTH CARE; RISK FACTORS; UNITED STATES;

EID: 0032014450     PISSN: 10628606     EISSN: None     Source Type: Journal    
DOI: 10.1177/106286069801300104     Document Type: Article

References (49)

1. Greene RJ, Kelly MA. Using outcome measures carefully-methodological hazards. J Outcomes Mgmt 1995:Fall;12-13.
2. Garnick DW, Hendricks AM, Comstock CB. Measuring quality of care: Fundamental information from administrative datasets. Int J Qual Health Care 1994;6:163-177.
3. Hornbrook M, Hurtado A, Johnson R. Health care episodes: Definition, measurement and use. Med Care Rev 1985;42:163-217.
4. Weiner JP, Starfield BH, Steinwachs DM, et al. Development and application of a population-oriented method of ambulatory care case-mix. Med Care 1991;29:452-472.
5. Averill RF, Goldfield NI, McGuire TE, et al. Design and evaluation of a prospective payment system for ambulatory care. Wallingford, CT: 3M Health Information Systems, 1990.
6. Fein O, Hoffman S, Brazel E. Looking at the patient in the mix: Is case mix methodology unfair to the hospital outpatient department? J Gen Intern Med 1988;3:471-475
7. Wingert TD, Kralewski JE, Lindquist TJ, et al. Constructing episodes of care from encounter and claims data: Some methodological issues. Inquiry 1995/96:32;430-443.
8. Solon JA, Feeney JJ, Jones S, et al. Delineating episodes of medical care. Am J Public Health 1967:401-408.
9. Hornbrook M. Definition and measurement of episodes of care in clinical and economic studies, 1993. Portland, OR: Center for Health Research, Kaiser Permanente.
10. Cave D. Profiling physician practice patterns using diagnostic clusters. Med Care 1995;33:463-486.
11. Shortell SM, Williams SJ, Richardson WC, et al. The Seattle prepaid health care project: comparison of health services delivery. Chap. VI: Integrative analysis based on episodes of care for hypertension and diabetes (Final Report). Seattle: Department of Health Services, School of Public Health and Community Medicine, University of Washington, November, 1976.
12. Lohr KN, Brook RH. Quality of care in episodes of respiratory illness among Medicaid patients in New Mexico. Ann Intern Med 1980;92:99-106.
13. Moscovice I. A method for analyzing resource use in ambulatory care settings. Med Care 1977;15:1024-1044.
14. Kristensen FB, Kelstrup J, Kholbau C, et al. Computer-based longitudinal recording of episodes of care in general practice using the international classification of primary care (ICPC). Scand J Primary Health Care 1993;11(suppl):53-56.
15. Nutting PA, Shorr GI, Burkhalter BR. Assessing the performance of medical care systems: A method and its application. Med Care 1981;19:281-296.
16. Shekelle PG, Markovich M, Louie R. Factors associated with choosing a chiropractor for episodes of back pain care. Med Care 1995;33:842-849.
17. Johnson RE, Vogt TM, Penn RL. An episode approach to the care and costs of obesity. J Ambulatory Care Mgmt 1984;7:47-61.
18. Salkever DS, Skinner EA, Steinwachs DM, et al. Episode-based efficiency comparisons for physicians and nurse practitioners. Med Care 1982;20:143-153.
19. Hillman B, Joseph C, Mabry M. Frequency and costs of diagnostic imaging in office practice - A comparison of self-referring and radiologist-referring physicians. N Engl J Med 1990;323:1604-1608.
20. Garnick D, Luft HS, Gardner LB, et al. Services and charges by PPO physicians for PPO and indemnity patients. Med Care 1990;28:894-906.
21. Gold M. Effects of hospital-based primary care setting on internists' treatment of primary care episodes. Health Serv Res 1981;16:383-405.
22. Lasdon GS, Sigmann P. Evaluating cost effectiveness using episodes of care. Med Care 1977;15:260-264.
23. Showstack JA, Garnick DW, Rosenfeld DE, et al. Episode-of-care physician payment: A study of coronary artery bypass graft surgery. Inquiry 1987;24:376-383.
24. Greenfield S, Rogers W, Mangotich M, et al. Outcomes of patients with hypertension and non-insulin-dependent diabetes mellitus treated by different systems and specialties. JAMA 1995;274:1436-1444.
25. Iezzoni LI. Risk adjustment for measuring health care outcomes. Ann Arbor, MI: Health Administration Press, 1994.
26. Lucas J, Gunter M, Byrnes J, et al. Integrating outcomes measurement into clinical practice improvement across the continuum of care: A disease-specific episode of care model. Managed Care Q 1995;3:14-22.
27. Bennett L. Employers are using "episodes of care" to improve benefits. Business and Health 1993:20-25.
28. National Heart Lung, and Blood Institute, National Institutes of Health, Guidelines for the diagnosis and management of asthma, August, 1991.
29. Gonnella JS, Hornbrook MC, Louis DZ. Staging of disease: A case-mix measurement. JAMA 1984;251:637-644.
30. Rosen AK, Geraci JM, Ash AS, et al. Postoperative adverse events of common surgical procedures in the Medicare population. Med Care 1992;30:753-765.
31. Iezzoni LJ, Schwartz M, Moskowitz MA, et al. Illness severity and costs of admissions at teaching and nonteaching hospitals. JAMA 1990;264:1426-1431.
32. Iezzoni LI, Daley J. A description and clinical assessment of the computerized severity index. Qual Rev Bull 1992;18:44-52.
33. Blumberg MS. Risk adjusting health care outcomes: a methodological review. Med Care Rev 1986;43:351-393.
34. Shaughnessy PW, Kramer AM, Hittle DF, et al. Quality of care in teaching nursing homes: findings and implications. Health Care Finance Rev 1995;16:55-96.
35. SAS Institute. SAS user's guide: statistics, version 6 edition. Cary, NC: SAS Institute, 1996.
36. Cave DG, Geehr EC. Analyzing patterns-of-treatment data to provide feedback to physicians. Med Interface 1994;7:117-126.
37. Hurtado AV, Greenlick MR. A disease classification system for analysis of medical care utilization, with a note on symptom classification. Health Serv Res 1971;6:235-250.
38. Gonnella JS, Louis DZ. Evaluation of ambulatory care. J Ambulatory Care Mgmt 1988;11:68-83.
39. Gonnella JS, Louis DZ, McCord JJ. The staging concept: An approach to the assessment of outcome of ambulatory care. Med Care 1976;14:13-21.
40. Markson LE, Nash DB, Louis DZ, Gonnella JS. Clinical outcomes management and disease staging. Eval Health Professions 1991;14:201-227.
41. Iezzoni LI, Foley SM, Daley J, et al. Comorbidities, complications, and coding bias: Does the number of diagnosis codes matter in predicting in-hospital mortality? JAMA 1992;267:2197-2203
42. Waterstaat FL, Barlow J, Newman F. Diagnostic coding quality and its impact on healthcare reimbursement: Research perspectives. J Am Record Assoc 1990;61:52-59.
43. Hsia DC, Krushat WM, Fagan AB, et al. Accuracy of diagnostic coding for Medicare patients under the prospective-payment system. N Engl J Med 1988;318:352-355.
44. Jencks SF, Williams DK, Kay TL. Assessing hospital-associated deaths from discharge data: The role of length of stay and co-morbidities. JAMA 1988;260:2240-2246.
45. Garnick DW, Hendricks AM, Comstock CB. A guide to using private insurance data for medical effectiveness research. Waltham, MA: Institute for Health Policy, Heller School, Brandeis University, 1993.
46. Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. N Engl J Med 1992;326:862-866.
47. McFadden ER. Fatal and near-fatal asthma. N Engl J Med 1991;324:409-412.
48. Mayo PH, Richman J, Harris HW. Results of a program to reduce admissions for adult asthma Ann Intern Med 1990;112:864-871.
49. Iglehart JK. Health policy report, the American health care system, managed care. N Engl J Med 1992;327:742-747.