Prescribing encounters can be sampled retrospectively, that is, by drawing random encounters from historical medical records, or they can be sampled prospectively, by collecting data from current patients as they present for treatment on the day of the study visit. Information on prescribing indicators can be collected by both methods. However, patient care and facility indicators always require the collection of prospective data.One of the key questions in deciding between retrospective and prospective data for the prescribing indicators is whether adequate sources of retrospective data exist. Possible retrospective sources of data can include chronological clinic registers, treatment records kept by individual prescribers, copies of drug prescriptions that are retained at the dispensary, or patient records kept at the health facility.Two essential elements that retrospective data sources must provide are: (1) a method of selecting a random sample of patient encounters that took place within a defined period of time; and (2) the specific names and routes of administration of all drugs prescribed.
If these are not available, prospective data are needed to measure the prescribing indicators.Records are typically kept as part of the normal morbidity or drug consumption recording systems, or else as part of a facility-based system of medical or pharmacy records.Retrospective data are usually easier to collect than prospective data, and suffer fewer potential biases. It is often possible to define a retrospective study period of a year or longer and spread cases throughout this period, which minimizes bias due to seasonal variations or interruptions in the drug supply cycle.The major weakness of retrospective data is that they are often incomplete. Individual or entire series of records can be missing, either because they were misplaced or because they were simply not recorded in the first place. In addition, the validity of retrospective data is often difficult to verify. Key data elements such as whether an injectable or oral form of a drug was ordered, or whether a drug was dispensed as prescribed, can be consistently missing or of uncertain accuracy.Prospectively collected data are usually complete. However, since prospective data are generally collected over a very short period they may suffer from biases due to seasonality, peculiarities in staffing, inconsistencies in the supply cycle, or most importantly, due to the fact that providers are aware that their behaviour is being observed. Of course, in the absence of retrospective sources of data study planners have little choice but to collect data prospectively and try to guard against these possible sources of bias.Pilot tests have shown that prospectively collected encounters can sometimes result in the prescribing indicators being biased in a “socially desirable” direction.
Significant reductions have been observed in the percentage of encounters receiving injections. The differences between retrospective and prospective measures for other indicators (fewer drugs and antibiotics) have generally been very small.If the medical record system can provide certain essential elements (a basis for sampling randomly within an identifiable period of time, name and route of delivery of all drugs prescribed), a retrospective sample has less chance of bias.
Prospective, retrospective or clinical audit: A label that sticks Analysis of clinical practice is integral to a practitioner’s professional responsibilities.
If historical data sources are non-existent or incomplete, or if there is a need to collect other data not included in historical medical records, then a prospective sample can be used to measure the prescribing indicators. Prospective sampling is also more appropriate to measure short-term changes in performance following an intervention.
Prospective payment plans assign a fixed payment rate to specific treatments based on predetermined factors. These payment rates may be adjusted periodically to account for inflation, cost of living in certain regions or other large scale economic factors - but not to accommodate individual patients.
Each health-care provider receives the same payment for each treatment of the same type. Multiple treatments of the same type receive multiple payments, however, each payment amount remains the same. Cases that require multiple treatments are segmented so that each treatment is assigned the corresponding payment rate.
Retrospective Payment Plan. Retrospective payment plans provide payment to health-care providers based on their actual charges. Under a retrospective payment plan, a health-care provider treats a patient and submits an itemized bill to the insurance provider describing the services provided. The insurance provider may approve or deny payment for specific services or for the entire bill. However, the customary procedure is that the health care provider receives payment for the full amount specified on the submitted bill without dispute from the insurance company. Along with the rise of managed care in the health-care field for private health-care providers, Medicaid programs in many states have converted from a retrospective payment plan to a prospective one. The fixed rates associated with a prospective payment plan have made calculating expenditures more predictable.
The move has also resulted in significant savings for many insurance companies. Some of these companies pass the benefits to consumers in the form of lower premiums and co-pays. Prospective Payment Plan Drawbacks.