The Journal of ambulatory care management
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This article examines the field of outcomes research from the perspective of a managed care organization, The Fallon Healthcare System, currently involved in many different types of studies. Outcome studies are characterized by the types of questions they examine. The cost and labor implications for each category are examined. Finally, a partnership among different participants in the outcome research field, including managed care organizations, academic institutions, and pharmaceutical companies, is proposed.
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A new "episode of care" definition of emergency care was developed, consisting of the emergency department encounter and all subsequent, related care delivered within 48 hrs from the initial contact. Data were analyzed by ICD-9-CM Major Diagnostic Category (MDC) and surgical intervention using 1.6 million episodes generated by 809,145 separate patients from a national claims database. ⋯ For several MDCs, hospitalization and/or surgical procedures were also major determinants of overall episodic charges. Results support the premise that economic analysis and reimbursement of emergency care benefits from the use of episodic data.