Episodes of Care: A Tool for Measuring the Impact of Healthcare Services on Cost and Quality
Episodes of care provide a clinically meaningful unit of analysis for measuring both the cost and quality of patient care. Many health plans are currently using episode of care grouping software in cost-focused provider profiling applications. These profiles compare the cost for one provider to treat an episode to the cost of specialty peers when treating episodes of the same condition. The next step in episode of care-based data analysis involves definition and incorporation of care-effectiveness measures. Effectiveness indicators should consider the ability or inability of prior care to meet both provider and patient expectations. Measures should further consider the underlying condition. Sample measures include inpatient stays following a period of ambulatory care, referrals following a period of treatment, changes in treatment regimen, and recurrences of the disease. Although difficult, quality measurement is necessary to show the value of healthcare spending.
Cost analysis, Managed care, Pharmacoeconomics, Quality of care
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