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BACKGROUND/RATIONALE:
Traditional healthcare assessments have focused on either inpatient or outpatient care, using the patient or provider as the unit of analysis. However, there is increasing recognition by VA and other healthcare organizations of the need to measure care across settings to account for the entire episode of care related to a given condition. EGs were designed explicitly for such purposes and are being used by growing numbers of non-VA healthcare organizations. However, their clinical validity has not been determined. Thus, further evaluation of these products is necessary to determine their utility to VA.
OBJECTIVE(S):
We will evaluate and compare Medstats Medical Episode Grouper (MEG) and Ingenix-Symmetry Episode Treatment Groups (ETGs) with respect to their ability to adequately group claims data representing an episode of care for each of four conditions: diabetes, depression, congestive heart failure (CHF), and chronic obstructive lung disease (COLD).
We will address the following specific questions:
1) How well does each EG meet criteria for episode measurement?
2) What is the clinic logic behind each EG? Do the diagnostic and procedure codes incorporated into each episode meet standards for face and clinical validity?
METHODS:
This is a retrospective observational study. Our sample consists of all veterans with a diagnosis of diabetes, depression, CHF or COLD using VA healthcare during FY05-FY07 with at least 2 continuous years of use. (FY05 will be used as a baseline year for disease severity.) We will obtain information on care from the VA National Patient Care Database supplemented by Decision Support System pharmacy files and Vital Status Files.
We will apply the grouper software to the database and compare MEG versus ETG output with respect to the following episode criteria including: 1)duration, 2)intensity, 3)disease severity, 4)number of comorbidities per patient, 5)number of days between visits,, and 7)outcomes including recurrences and death. Analyses will include correlation coefficients, cross-tabulations, and kappa statistics as appropriate to compare EGs on specific outputs.
For objective 2, we will randomly selected 25 episodes per condition for each of the EGs. Four clinicians will examine the face and clinical validity underlying the grouping logic of each of the EGs using explicit review criteria based on Hornbrooks framework and clinical logic. Each clinician will examine the EG output for 2 conditions (100 cases each).
This work will form the basis for further studies examining the construct validity of the groupers.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
There is increasing interest by healthcare organizations, including VA, in measuring care for chronic conditions across healthcare settings. How to best measure such episodes of care is unclear. Despite this, there are 2 commercially available episode grouper (EG) software products that are widely used by non-VA healthcare organizations. This pilot project will examine the face and clinical validity of the grouping logic used in these EGs with respect to four prevalent chronic conditions in VA. This work represents an important step toward further assessment of these episode measurement tools and more comprehensive assessment of the quality of care delivered to veterans.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Resource Use and Cost
Keywords:
Research measure, Research method
MeSH Terms:
none
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