Episodes of care: theoretical frameworks versus current operational realities.

Background: Fundamental changes in the structure of the health care industry have stimulated the need for improved definitions of output and for better methods of organizing utilization data into appropriate units. Although the "episode of care" concept has existed since the 1960s, its recognition as integral to the management of health care cost and utilization is relatively recent. Conceptually, episodes of care represent a meaningful unit of analysis for assessing the full range of primary and specialty services provided in treating a particular health problem.

Developing a tool for analyzing medical care utilization of adult asthma patients in indemnity and managed care plans: can an episodes of care framework be used?

We evaluated the health care resource utilization between adult asthma patients in managed care organizations with those in indemnity plans using an episodes of care methodology. We also examined the importance of risk adjustment in explaining variation in resource utilization. Episodes were constructed using private insurance claims from 1992 to 1993.

Developing episodes of care for adult asthma patients: a cautionary tale.

An episodes of care methodology examines the contiguous cluster of services related to a particular health condition. We developed an episodes methodology for evaluating the quality of health care delivery to privately insured adult asthma patients. Computer algorithms were used for episode construction beginning with an index asthma diagnosis and ending with a final clinical event, yielding a sample of 30,553 episodes.

Screening for depression among a well elderly population.

This article describes a geriatric wellness program in which social work practitioners played a major role. The focus of this article is twofold: to examine the use of a telephone screening test for depression among a well elderly population and to compare the results of that screening with the clinical judgment of social workers. Overall findings indicated that a telephone screening instrument incorporating the Rand Mental Health Inventory and the Center for Epidemiological Studies Depression Scale was an efficient tool for assessing a population with a higher rate of major depression.

Predicting future functional status for seriously ill hospitalized adults. The SUPPORT prognostic model.

Objective: To develop a model estimating the probability of an adult patient having severe functional limitations 2 months after being hospitalized with one of nine serious illnesses.

Design: Prospective cohort study.

Setting: Five teaching hospitals in the United States.

Comparisons between dentist ratings and self-ratings of dental appearance in an elderly population.

Little is known about dental appearance in terms of the elderly population. The purpose of this paper is to compare self-reported dental appearance with dentist-rated appearance for individuals over 65. The subjects (N = 550) were participants in the Los Angeles based Medicare Screening and Health Promotion Trial.

Enrolling community physicians and their patients in a study of prevention in the elderly.

Enrollment of senior citizens in a community Medicare demonstration project to explore the efficacy of preventive health screening and health education was accomplished by using a two-stage process. This process consisted of initial communication with community physicians through the University of California at Los Angeles Clinical Faculty Association to establish credibility for the program. Physicians who agreed to participate then selected potential participants to receive, by mail, a description of the study and an introductory letter from their own physician.

Appropriateness of acute medical care for the elderly: an analysis of the literature.

Over the past 30 years, an explosion in health care expenditures has occurred. Prior to 1960, health care accounted for 4.4% of the U.