Menke TJ, Wray NP, Ashton CM, Rabeneck L; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1999; 16: 360.
Houston Center for Quality of Care and Utilization Studies, VAMC (152) 2002 Holcombe Blvd., Houston, TX 77030, USA.
OBJECTIVE: To define episodes of care that include hospitalizations, including the time frames for pre and post-hospital care, and the types of health care. STUDY DESIGN: An expert panel of physicians selected high-volume diagnoses or surgical procedures to examine, and developed criteria for defining episodes of care. Among the conditions selected were: coronary artery bypass, colon cancer procedures, total hip replacement, bleeding ulcer, and congestive heart failure. For each condition selected, computer printours of Department of Veterans Affairs administrative data from FY1997 were generated of the frequency of: (1) visits by clinic stop, by month, from 6 months prior to admission to 6 months following discharge; (2) outpatient tests and procedures by CPT code for relevant organ systems, by month, from 6 months prior to admission to 6 months following discharge; (3) readmissions by ICD-9 code of the primary diagnosis and procedure, by week, up to 6 months following discharge; and (4) nursing home stays, by week, up to 6 months following discharge. For each condition selected, the expert panel used their clinical knowledge and the computer printouts to determine how long prior to the hospitalization the episode began, how long after discharge the episode ended, and which specific outpatient visits, tests, readmissions, and nursing home stays should be included in the episodes. PRINCIPAL FINDINGS: Episodes of care for surgical hospitalizations took the following general form. Episodes of care for medical diagnoses were defined analogously. (1) Pre-admission care: (a) started 90 days prior to admission for most surgeries; (b) included visits to principal medicine clinics, relevant medical specialty and surgery clinics, nursing, relevant behaqvioral counseling, and clinics designated as pre-operative; and (c) included outpatient tests or procedures specific to the evaluation of the extent or indication for surgery. (2) Post-discharge outpatient care: (a) included visits to principal medicine or nursing clinics within 4-6 weeks after discharge, depending on the surgery; and (b) included visits to all other clinics specified in (1) and relevant rehabilitation visits up to 6 months following discharge. (3) Readmissions: (a) were all included up to 1-6 weeks fter discharge, depending on the surgery; (b) were included in the episode based on containing a relevant surgical procedure or primary diagnosis if they occurred between the time specified in (a) and 6 months after discharge. (4) Nursing home stays were inclded if they immediately followed the initial hospitalization, or a readmission that was included in the episode. CONCLUSIONS: A process combining clinical knowledge and relevant data was developed for defining episodes of care that include a hospitalization. IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: Current organizational features of health care have shifted the focus of quality and efficiency evaluation from the health care event (e.g. hospitalization) to the entire package of services required to treat an episode of illness. The algorithms developed in this study can be applied by managers or researchers who want to examine the costs, efficiency, or outcomes for episodes of care.
Publication Types:
Keywords:
- Ambulatory Care Facilities
- Hospitalization
- Nursing Homes
- Outpatients
- Patient Discharge
- methods
- surgery
- hsrmtgs
Other ID:
UI: 102194707
From Meeting Abstracts