Quality rating tool for the health care industry

• US 20030163349A1
• Filed: 02/28/2002
• Published: 08/28/2003
• Est. Priority Date: 02/28/2002
• Status: Abandoned Application

• Current Assignee: PacifiCare Health Systems LLC (UnitedHealth Group Incorporated)
• Original Assignee: PacifiCare Health Systems LLC (UnitedHealth Group Incorporated)
• Inventors: Ho, Samuel W.
• Application Number:
  US10/086,557
• Publication Number:
  US 20030163349A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

A quality rating tool used for evaluating health care providers, such as medical groups or hospitals, and a method of creating a quality rating are described. A quality rating tool is organized based on medical groups and contains numerous measures that a health care consumer can use to determine a medical group best suited to the consumer'"'"'s conditions and needs. The measures include safe dosing of pain killers, use of preferred antibiotics, and overuse of antibiotics in the clinical measures category and member cost pharmacy and member cost emergency room in the affordability measures category. Values in the quality rating for these measures and others are percentiles and, as such, inform the health care consumer of where a particular medical group ranked with respect to a specific measure. The quality rating tool is compiled by an organization having access to large volumes of consumer and physician data and data from numerous other sources such as hospitals and databases of pharmacy, emergency room, professional encounter claims data, as well as consumer complaint databases and survey forms.

Claims

1. A quality rating tool comprising:

a listing of one or more entities, an entity being a type of health care provider; and

a measure indicating the frequency with which a level of dosing of a medication was prescribed by an entity, wherein the quality rating tool is used to select an entity for providing health care services to a health care consumer.

2. A quality rating tool as recited in claim 1 wherein the medication includes painkillers.

3. A quality rating tool as recited in claim 2 wherein the measure is derived from a number of prescriptions in which a predetermined amount by weight of painkillers is not exceeded.

4. A quality rating tool as recited in claim 3 wherein the predetermined dosage is four grams and the painkiller is acetaminophen (APAP).

5. A quality rating tool as recited in claim 1 wherein the level of dosing indicated is a safe level of dosing.

6. A quality rating tool as recited in claim 1 wherein an entity is a medical group.

7. A quality rating tool as recited in claim 1 wherein an entity is a hospital.

8. A quality rating tool as recited in claim 1 wherein the measure is categorized in a clinical measures category.

9. A quality rating tool as recited in claim 8 wherein the measure is further categorized in a patient safety category.

10. A quality rating tool comprising:

a listing of one or more entities, an entity being a type of health care provider; and

a measure indicating the frequency with which use of an antibiotic for treating a condition is prescribed by an entity, wherein the quality rating tool is used to select an entity for providing health care services to a health care consumer.

11. A quality rating tool as recited in claim 10 wherein the measure is an indication of a number of prescribed antibiotics where the prescribed antibiotics are medically accepted for initiating treatment of a condition.

12. A quality rating tool as recited in claim 10 wherein the condition includes bronchitis.

13. A quality rating tool as recited in claim 10 wherein the measure is derived from a number of preferred antibiotic prescriptions and a number of total antibiotic prescriptions for treating the condition.

14. A quality rating tool as recited in claim 10 wherein an entity is a medical group.

15. A quality rating tool as recited in claim 10 wherein an entity is a hospital.

16. A quality rating tool as recited in claim 10 wherein the measure is represented in the quality rating tool as a percentile ranking.

17. A quality rating tool as recited in claim 10 wherein the measure is categorized in a clinical measures category.

18. A quality rating tool as recited in claim 17 wherein the measure is further categorized in a patient safety category.

19. A quality rating tool comprising:

a listing of one or more entities, an entity being a type of health care provider; and

a measure indicating the frequency with which appropriate diagnostic testing was performed when prescribing antibiotics for a condition, wherein the quality rating tool is used to select an entity for providing health care services to a health care consumer.

20. A quality rating tool as recited in claim 19 wherein the measure is an indication of a number of prescriptions that correspond with appropriate diagnostic testing.

21. A quality rating tool as recited in claim 19 wherein the measure is derived from a number of prescribed antibiotics that correspond with appropriate diagnostic testing and a number of patients with the condition.

22. A quality rating tool as recited in claim 21 wherein the condition includes pharyngitis.

23. A quality rating tool comprising:

a listing of one or more entities, an entity being a type of health care provider; and

a measure indicating the cost of health services and products incurred by a health care consumer obtaining health care services from an entity, wherein the quality rating tool is used to select an entity for providing health care services.

24. A quality rating tool as recited in claim 23 wherein a measure indicating the cost of health services and products incurred by a health care consumer includes a measure indicating pharmaceutical costs incurred by a health care consumer.

25. A quality rating tool as recited in claim 23 wherein a measure indicating the cost of health services and products incurred by a health care consumer includes a measure indicating emergency medical costs incurred by a health care consumer.

26. A quality rating tool measuring the performance of a medical group from a plurality of medical groups, the quality rating tool comprising:

a safe dosing of a medication measure;

a use of preferred antibiotics measure; and

a overuse of antibiotics measure, wherein the quality rating tool is used by a health care consumer in selecting an appropriate medical group.

27. A quality rating tool measuring the performance of a medical group from a plurality of medical groups, the quality rating tool comprising:

a member pharmaceutical cost measure; and

a member emergency services cost measure wherein the quality rating tool is used by a health care consumer in selecting an appropriate medical group.

28. A method of creating a quality rating tool in the health care industry, the method comprising:

selecting a unit of analysis which defines the granularity of the quality rating tool;

collecting data from a plurality of sources relating to a plurality of measures used in the quality rating tool;

calculating a score for a measure from the plurality of measures using data from the plurality of sources, wherein the measures include a safe dosing of a medication measure

29. A method of creating a quality rating tool in the health care industry, the method comprising:

selecting a unit of analysis which defines the granularity of the quality rating tool;

collecting data from a plurality of sources relating to a plurality of measures used in the quality rating tool;

calculating a score for a measure from the plurality of measures using data from the plurality of sources, wherein the measures include use of preferred antibiotics measure.

30. A method of creating a quality rating tool in the health care industry, the method comprising:

selecting a unit of analysis which defines the granularity of the quality rating tool;

collecting data from a plurality of sources relating to a plurality of measures used in the quality rating tool;

calculating a score for a measure from the plurality of measures using data from the plurality of sources, wherein the measures include an overuse of antibiotics measure.