CONSTRUCTING EPISODES OF CARE FROM ENCOUNTER AND CLAIMS DATA - SOME METHODOLOGICAL ISSUES

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 whi ch they were prescribed. This paper presents a computerized approach f or developing episodes of care from encounter and claims data and disc usses some methodological issues. We found that we could group into fi ve generic types of episodes of care the 31 illnesses that incur the m ajority of expenses for a health maintenance organization. This articl e describes the process for developing these types and summarizes the specific criteria defining the episodes of care for the 31 illnesses.