Patients classification System

tools for
Cost management

tools for
Quality management

tools for

4  Why to choose US

4  implementation


4  contact

4  Logic

4  diagnoses

4  procedures

4  inpatients

4  outpatients

4  insurance

4  readmissions

4  reoperations

4  complications

4  deaths

4  length of stay

4  day surgery

4  unjustified stays

Aim                                  To measure the costs of outpatients’ episodes.

Observed costs              The costs are allocated to episodes of care, i.e. series of medical visits without interruption of more than six months. Each episode is related to a patient and a physician. A specific cost accounting method is applied to ambulatory episodes of care. 4  COST ACCOUNTING

Expected costs               Expected costs are computed from the average costs per illness, computed from a sample of about 2 millions of Swiss insured (2005-2006). Similarly to inpatients, expected costs were computed among physicians with a cost ratio lower than 1.0 (benchmark).

The illnesses are inferred from physicians’ drugs prescriptions and from hospital diagnoses if available. If no clinical information is available, the physicians’ specialties or the age and gender of the patients are used. Only the most severe conditions are retained, with a special focus to avoid multiples conditions if they conduct to overestimates costs. 4  Logic

A special attention is given to the choice of which prescriptions can be used or not to infer illnesses, according the recommendations we made in a recent scientific paper:

Halfon P, Eggli Y, Decollogny A, Seker E. Disease identification based on ambulatory drugs dispensation and in-hospital ICD-10 diagnoses: a comparison. BMC Health Services Research 2013 ;13:453.

4  scientific paper

Implementation              Because available data vary considerably from a user to another, there is no totally automatized SQLape® tool. Please contact us if you are interested, to see which solution might be implemented.

© SQLape s.à.r.l. 2014. Last update: 20.05.2014