On Sat, 2004-11-20 at 20:19, Thomas Beale wrote: > >and http://snipurl.com/armv
(which is the Australian definition) > > > Defintion from this link: > The period of admitted patient care between a formal or statistical > admission and a formal or statistical separation, characterised by only > one care type. > > I personally think this is not that useful, since older and complex > patients just don't have only one care type (which I take to mean > specialty). Although you would never know it from the web page, by "care type", they mean "acute care" versus "rehabilitation" versus "psychiatric". These distinctions are purely administrative and have no definitive clinical or epidemiological meaning. Nevertheless, it is teh basis of all official Australian hospital statistics. The British definitions are much better, I think. > > I would suggest that the most meaningful defintion of "episode" is more > like the Mayo one - an admission (= acceptance by a provider institution > to undertake provision of healthcare to a patient) to the point in time > when the same institution performs a transfer of care to another > provider - a referral of some kind to e.g. the GP, aged care home, > self-care at home. We refer to that as a "separation" - which begins with inpatient admission to a healthcare facility and ends with discharge, transfer or death. You also need rules for "leave" - some patients (eg long-term psych patients, rehab patients) go on leave during the course of one admission/separation. > But we also have to ask the question of what use is knowing where the > boundaries of an episode are. Clearly cost accounting occurs at a much > finer level of detail, which is easily supported by models like openEHR > (to our knowledge to date at least); Hospital- and ward-level cost accounting might take place at finer levels of detail, but hospital funding tends to use these administrative/"statistical" definitions, as noted in the BMJ article. An EHR repository will not curry much favour with administrators (who tend to hold the purse-strings) if it can't give them the information they want (which is not necessarily what they need...) > it seems to me that an episode is > more to do with a period of legal responsibility of care by a provider > (institution). Episodes could be called "funding temporal units". Tim C - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
