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Chronic Obstructive Pulmonary Disease (COPD) ECR® Playbook
- Methodology
- Clinical Guidelines. This zipped file
contains the following publications which were used in
the development of the ECR:
- ECR Definition
Summary. This document presents a
brief summary of key ECR definitions (e.g. types of
models developed, trigger codes, episode period, exclusions,
etc.). It is intended to be a quick reference for key
definitions, which are described fully in the Chronic
Medical ECR Dataset Instructions.
- Chronic Medical
ECR Dataset Instructions. This document
contains instructions for constructing the ECR datasets,
which are used for the typical and potentially avoidable
complications (PAC) analyses. This document was formerly
referred to as the “Analysis Plan”.
- Statistical
Analysis Plan. The Statistical Analysis
Plan describes the statistical analysis methods used
to develop the typical regression model. This model
can be used to estimate severity-adjusted costs for
typical care.
- All Codes. This workbook contains code definitions
(using ICD-9-CM codes, HCPCS, etc.) for the episode
triggers, the risk factor variables (“RF” variables),
comorbidities (“M”), procedures (“P”),
and PAC variables (“PAC”). It does not
contain pharmacy variables, which are in the Pharmacy
All Codes file (listed below). The Chronic Medical
ECR Dataset Instructions refers to code definitions
in the All Codes workbook.
- Pharmacy
All Codes. This workbook lists the pharmacy
variables and, for each, whether claims with
the pharmacy variable should be deleted or should be
considered
typical or PAC. The Chronic Medical ECR Dataset
Instructions
refer to the Pharmacy All Codes workbook.
- Summary Results.
- Data flow. This workbook presents the following summary
data:
- Decision Tree. This tree diagram shows an outline of
the decisions made during the process of constructing episodes.
The number of episodes and costs for
selected steps in the process are presented.
- Complete Data Flow. This table shows patient
counts, claim counts, and cost statistics for
selected steps from the Chronic Medical ECR Dataset
Instructions.
- Data Flow Overview. This table shows patient
counts and cost statistics for the relevant,
typical, and PAC services. The results are broken
down
further
by stay, professional, and pharmacy. This table is also presented in the
PAC analysis below.
- Episode Allocation Graph. This graph shows the
number of episodes in the typical and PAC groups
and the overlap of the groups.
- Dollar Allocation Graphs. These graphs show how
total costs are distributed by the typical and
PAC groups.
- Demographics. This file shows demographic data (age,
gender) for relevant episodes.
- Predictor
Frequencies. This document shows the frequency
of each predictor (e.g. comorbidities, procedures, etc.)
in the typical sample.
- Analysis
- PAC
Allowance. This workbook shows the PAC allowance and ECR
price calculations as well as the information used to do
those calculations:
- Data Flow Overview. This table shows patient counts
and cost statistics for relevant, typical, and
PAC services. The results are broken down further
by
stay, professional, and pharmacy. This table also appears in the Data
Flow workbook.
- Core Services Pricing. This table shows the core
set of services and quantity of services that
are recommended by Clinical Practice Guidelines
or expert
opinion. The table also shows the total price for the core set of services.
This price is used to determine the underuse adjustment.
- Severity-Adjusted Price. This table
shows the computation of the severity-adjusted
base price
of ECR for typical care. Prices for three
hypothetical patients
are shown. These prices are used in the Construction of the
ECR (see tab entitled “PAC
Allowance” in this workbook). The final regression model
(from the Typical Analysis Results workbook) is used to do
the calculations.
- PAC Allowance Computation & ECR Construction. This table shows
how to calculate the PAC allowance, make adjustments for underuse and
care coordination,
calculate the margin and, together with the severity-adjusted base price
of the ECR, helps determine the total ECR price in three hypothetical
patient
scenarios.
- Payer Savings Graph. This graph shows how typical
and PAC dollars can be redistributed to reduce
PAC costs within Prometheus.
- PAC
Diagnoses. This workbook shows PAC costs overall
and by diagnosis.
- PAC Costs Overview. This table shows the percentage
of relevant costs that are PACs and how PAC costs
are distributed by professional, stay, and pharmacy.
- PAC Professional Costs by Diagnosis. This section
shows the number of occurrences and associated
costs of PAC diagnoses on PAC professional claims.
All diagnoses
displayed are potentially actionable.
- PAC Stay Costs by Principal Diagnosis. This worksheet
presents the number of stays and associated costs
of the principal diagnoses
of PAC stays.
All diagnoses displayed are potentially actionable.
- Typical Analysis
Results. This workbook contains the
results of analyzing the typical episodes. The data are
presented
on the trimmed typical sample (described in the Statistical
Analysis Plan).
- Allowed Amount. This spreadsheet shows descriptive
statistics (mean, standard deviation, etc.) for
allowed amount.
- Age Distribution. This page shows descriptive
statistics (mean, standard deviation, etc.) for
age.
- Ln(Allow) vs. Age. This page contains a graph
of allowed amount on the natural log scale vs.
age. The graph shows whether allowed
amount increases
or decreases
with age, and also whether age should be modeled as a linear, quadratic
or some other type of variable.
- Comorbidities, etc. These graphs show the distribution
of the number of comorbidities, procedures, and
medications per episode.
- t tests. To determine whether there was a significant
difference in allowed amount by each predictor
variable, t tests were done.
Descriptive statistics
(count, percent, mean, standard deviation) for allowed amount
by each risk factor variable are shown in addition to the t
test results.
- Final Model fit. This spreadsheet shows the adjusted
R-square and the number of episodes used for
the final model.
- Final Model. This page shows the final severity-adjusted
model used to predict costs of typical episodes. All predictors
in
the final model and
their regression
coefficients, standard errors, and p-values are shown.
- ECR Price Calculator. This worksheet allows the
user to compute severity-adjusted base prices
for typical care
for
hypothetical
patients. The user can select
desired comorbidity, procedure, and pharmacy variables
(if included in the model). The worksheet uses the Final
Model
to do the calculations.
Instructions
are provided at the bottom of the worksheet.
References
a - Akazawa M, Hayflinger DC, Stanford RH, Blanchette
CM. Economic Assessment of Initial Maintenance Therapy for
Chronic
Obstructive
Pulmonary Disease. Am
J Manag Care 2008;14(7):438-448.
b - Marton JP, Boulanger L, Friedman M, Dixon D, Wilson
J, Menzin J. Assessing the costs of chronic obstructive pulmonary
disease: The state medicaid perspective. Respiratory
Medicine 2006;100:996–1005.
h
c - Mickman J, Horn A, Kerestes GP, Youngman C, Larson
S, Gillespie D, McEvoy C, Copeman S, Norton J, Hunteman T,
Setterlund
L.
ICSI health care guideline: Chronic
Obstructive Pulmonary Disease. Institute for Clinical Systems
Improvement, January 2007, 6th
edition.
**Prometheus
Payment owns all rights to the ECRs® and the materials
on the site and that these materials should not be reproduced
without proper attribution.**
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