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

Abstract

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.

Alcoholism treatment episodes validly defined using mental health care utilization records

“…Elements required to delimit a specific episode of care include diagnostic information, well-defined starting and stopping points, and a particular course or dosage of treatment [1,2]. Hornbrook et al [1] and others have advocated the use of an episode of care methodology in health outcomes research because "the episode defines the boundaries of a particular health care process and a means in which to sum the total number of health care inputs occurring during a specified illness or problem."…”

“…The first element in identifying the boundaries of an episode of care is to determine the point at which it begins. Criteria for establishing the beginning of an episode include the first encounter of a patient with the health care provider related to a particular health care problem [2] or point in time where medical care expenditures related to an illness first exceed levels prior to illness [3]. Next, the end of an episode of care must be identified.…”

“…An episode of care is defined in the literature as a sequence or cluster of health care services related to a particular condition or disease [1,2]. Elements required to delimit a specific episode of care include diagnostic information, well-defined starting and stopping points, and a particular course or dosage of treatment [1,2].…”

An Episode‐Based Framework for Analyzing Health Care Expenditures: An Application of Reward Renewal Models

“…4. One also could allow the definition of a ''clean period'' to vary with diagnosis or even the severity of the condition (Rosen et al 1998;Wingert et al 1995/6). 5.…”

“…Ascertaining such linkages, however, is difficult, potentially requiring reviews of patient records or interviews with providers. For this reason, researchers also have defined episodes in terms of spells of continuous treatment; the end of the episode is marked by a ''clean period'' in which services (and/or medications) are not received (Rosen et al 1998). Such periods might involve interruptions in treatment longer than some threshold, such as 45, 56, or 90 days (Kessler, Steinwachs, and Hankin 1980;Wells et al 1996;Holmes and Deb 1998;Busch 2002).…”