Estimating Episodes of Care Using Linked Medical Claims Data

Abstract

Australia has extensive administrative health data collected by Commonwealth and state agencies. Using a unique cleaned and linked administrative health dataset we address the problem of empirically defining episodes of care. An episode of care is a time interval containing medical services relating to a particular medical situation. In this paper the medical situation is a hospital admission. The medical services of interest are pathology tests,diagnostic imaging and non-invasive investigative procedures performed before or after the hospital admission, but ‘associated’ with the hospital admission. The task can be viewed as detecting a signal in a time series relating to a hospital admission,distinct from the background noise of on-going medical care. Our approach uses an ensemble (panel of experts) paradigm where we implement multiple agents (alternative predictive models) to separately estimate intervals and then choose a robust interval estimate using a voting scheme. The results have been used in a study for the Commonwealth Department of Health and Ageing.