Constructing episodes of care from encounter and claims data: some methodological issues.

T D Wingert; J E Kralewski; T J Lindquist; D J Knutson

PubMed · 8567080

Constructing episodes of care from encounter and claims data: some methodological issues.

T D Wingert·J E Kralewski·T J Lindquist·D J Knutson

Abstract

There is growing agreement that episodes of care methodology provides the most effective means of analyzing health care delivery because it organizes health care services around the condition or illness for which they were prescribed. This paper presents a computerized approach for developing episodes of care from encounter and claims data and discusses some methodological issues. We found that we could group into five generic types of episodes of care the 31 illnesses that incur the majority of expenses for a health maintenance organization. This article describes the process for developing these types and summarizes the specific criteria defining the episodes of care for the 31 illnesses.

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Algorithms Chronic Disease Diagnosis-Related Groups Episode of Care Fees and Charges Female Health Maintenance Organizations Health Services Research Humans Insurance Claim Reporting Mathematical Computing Minnesota Pregnancy Software Journal Article Research Support, Non-U.S. Gov't

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T D Wingert, J E Kralewski, T J Lindquist, D J Knutson. Constructing episodes of care from encounter and claims data: some methodological issues.. https://pubmed.ncbi.nlm.nih.gov/8567080/

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