دورية أكاديمية
أعرض في EDS

Characterizing managing physicians by claims sequences in episodes of care.

التفاصيل البيبلوغرافية
العنوان: Characterizing managing physicians by claims sequences in episodes of care.
المؤلفون: Staples LL; Analytics and Data Science Institute, Kennesaw State University, GA, USA; Provider Performance Analytics, BlueCross BlueShield of Tennessee, TN, USA., Tamayo M; Analytics and Data Science Institute, Kennesaw State University, GA, USA; Provider Performance Analytics, BlueCross BlueShield of Tennessee, TN, USA., Yockey BD; Analytics and Data Science Institute, Kennesaw State University, GA, USA; Provider Performance Analytics, BlueCross BlueShield of Tennessee, TN, USA., Rudd JM; Analytics and Data Science Institute, Kennesaw State University, GA, USA; Provider Performance Analytics, BlueCross BlueShield of Tennessee, TN, USA., Hill N; Provider Performance Analytics, BlueCross BlueShield of Tennessee, TN, USA., Fontana SJ; Provider Performance Analytics, BlueCross BlueShield of Tennessee, TN, USA. Electronic address: scott_fontana@bcbst.com., Ray HE; Analytics and Data Science Institute, Kennesaw State University, GA, USA., DeMaio J; Analytics and Data Science Institute, Kennesaw State University, GA, USA.
المصدر: Journal of biomedical informatics [J Biomed Inform] 2021 May; Vol. 117, pp. 103759. Date of Electronic Publication: 2021 Mar 22.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 100970413 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-0480 (Electronic) Linking ISSN: 15320464 NLM ISO Abbreviation: J Biomed Inform Subsets: MEDLINE
أسماء مطبوعة: Publication: Orlando : Elsevier
Original Publication: San Diego, CA : Academic Press, c2001-
مواضيع طبية MeSH: Episode of Care* , Physicians*, Cohort Studies ; Delivery of Health Care ; Health Care Costs ; Humans ; Tennessee ; United States
مستخلص: Value-based healthcare in the US is a payment structure that ties reimbursement to quality rather than volume alone. One model of value-based care is the Tennessee Division of TennCare's Episodes of Care program, which groups common health conditions into episodes using specified time windows, medical code sets and quality metrics as defined in each episode's Detailed Business Requirements [1,2]. Tennessee's program assigns responsibility for an episode to a managing physician, presenting a unique opportunity to study physician variability in cost and quality within these structured episodes. This paper proposes a pipeline for analysis demonstrated using a cohort of 599 Outpatient and Non-Acute Inpatient Cholecystectomy episodes managed by BlueCross BlueShield of Tennessee in 2016. We sorted episode claims by date of service, then calculated the pairwise Levenshtein distance between all episodes. Next, we adjusted the resulting matrix by cost dissimilarity and performed agglomerative clustering. We then examined the lowest and highest average episode cost clusters for patterns in cost and quality. Our results indicate that the facility type where the surgery takes place is important: outpatient ambulatory care center for the lowest cost cluster, and hospital operating room for the highest cost cluster. Average patient risk scores were higher in the highest cost cluster than the lowest cost cluster. Readmission rate (a quality metric tied to managing physician performance) was low for the whole cohort. Lastly, we explain how our analytical pipeline can be generalized and extended to domains beyond Episodes of Care.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
فهرسة مساهمة: Keywords: Claims; Clustering; Data; Edit distance; Episodes; Healthcare; Levenshtein; Physicians; Value-based
تواريخ الأحداث: Date Created: 20210326 Date Completed: 20210727 Latest Revision: 20210727
رمز التحديث: 20240628
DOI: 10.1016/j.jbi.2021.103759
PMID: 33766779
قاعدة البيانات: MEDLINE
الوصف
تدمد:1532-0480
DOI:10.1016/j.jbi.2021.103759