An Episode Approach to Utilization, Costs, and Effectiveness in Health Care

摘要

Using its exceptional data base for a 5% sample of enrolled members, the Kaiser-Portland Health Services Research Center undertook development of a methodology for identifying, costing and examining alternative resource bundles used in ambulatory care of defined conditions. Results and detailed analysis are presented for 11 conditions: Obesity, Acute Cystitis, Hypertension, Hemorrhoids, Otitis Media, Fever of Unknown Origin, Headache, Depression, Breast Lump, Shoulder Bursitis and Gonorrhea. For 10 of these distinct treatment bundles (ranging from 3 to 10 alternatives per condition) emerged which explained between 50 and 70% of the observed cost variation (which for most conditions was quite substantial). Patient and/or provider characteristics explained 29% of cost variations for five conditions, between 14 and 19% for others, and less than 10% for the remaining two. There is some indication that laboratory tests and drug orders may substitute for office visits for some conditions. But the authors caution that their results are not yet suitable for use in determining medical policy. They conclude with a description of what further research might be done to strengthen policy applications of their approach, including 8 methodological imperatives.