System and method for peer-profiling individual performance

• US 20060241974A1
• Filed: 04/21/2006
• Published: 10/26/2006
• Est. Priority Date: 04/26/2005
• Status: Active Grant

• Current Assignee: Advisory Board Company (UnitedHealth Group Incorporated)
• Original Assignee: Advisory Board Company (UnitedHealth Group Incorporated)
• Inventors: Chao, David Yung-Min, Chan, William Wyeleem, Kadyan, Mike Vineet
• Granted Patent: US 8,082,172 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 10/06393 Score-carding, benchmarking or key performance indicator [KPI] analysis
• CPC Class Codes: G06Q 10/06398 Performance of employee with respect to a job function
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

Embodiments of the invention provide a comprehensive, automated system and method for evaluating the performance of individuals or entities employed by an organization, particularly useful in peer-profiling physician performance in multi-facility environments. Embodiments of the invention can dynamically compose a virtual peer or group of peers and perform peer-profiling on each individual or group of individuals to be evaluated. For example, a composite physician may be generated from system-wide and/or state-wide healthcare data as a benchmark against which a particular physician is profiled according to industry-standard measurements. The composite physician would have equivalent or similar job function(s) as well as patient population. The composite physician enables a comprehensive “apple to apple” comparison with the particular physician, giving meaning to and facilitating the usefulness of performance evaluation results.

Claims

1. A method for peer-profiling performance of an entity, comprising:

generating a performance profile of said entity, wherein said entity is representative of one or more individuals;

constructing a virtual peer having an equivalent performance profile; and

comparing said performance profile of said entity with said equivalent performance profile of said virtual peer.

2. The method of claim 1, wherein the step of generating a performance profile of said entity comprises, for each applicable measure, determining an entity average based on a group of cases that meet a set of criteria and for which said entity is responsible within a specified time period at an organization.

3. The method of claim 2, wherein the step of constructing a virtual peer having an equivalent performance profile comprises determining a peer average for said measure based on a composite of cases selectively obtained from a data source, wherein said composite of cases is selected to match said group of cases.

4. The method of claim 3, wherein the step of determining an entity average further comprises:

calculating an average value m for said group of cases for said measure; and

calculating M_individual, where M_individual is representative of said entity average, where

$M_{\mathrm{individual}}=\frac{\underset{i}{\sum <br><br>}<br><br>n_i<br><br>m_i}{\underset{i}{\sum <br><br>}<br><br>n_i}<br><br>\text{\hspace{1em}<br><br>}<br><br>\mathrm{and}<br><br>\text{\hspace{1em}<br><br>}<br><br>\mathrm{where}$

i is representative of said group and n is representative of a number of cases that meet said set of criteria within said specified time period; and

wherein the step of determining a peer average further comprises;

calculating an average value m′

for said composite of cases for said measure; and

calculating M_peer, where M_peer is representative of said peer average and where

$M_{\mathrm{peer}}=\frac{\underset{i}{\sum <br><br>}<br><br>n_i<br><br>m_i^{\mathrm{\prime <br><br>}}}{\underset{i}{\sum <br><br>}<br><br>n_i}.$

5. The method of claim 3, wherein said data source is representative of a hospital, a hospital system, a state agency, a national agency, an international agency, or an independent agency.

6. The method of claim 2, wherein said applicable measure is selected from a plurality of measures conforming to measures from Joint Commission on Accreditation of Healthcare Organizations, or Agency for Healthcare Research and Quality.

7. The method of claim 1, wherein said individuals are healthcare or medical professionals, including physicians, doctors, and nurse practitioners.

8. The method of claim 1, wherein the step of generating a performance profile of said entity comprises obtaining data on a plurality of cases for which said entity is responsible within a specified time period at an organization, wherein said plurality of cases are classifiable into a plurality of groups according to an industry standard.

9. The method of claim 8, further comprising segmenting said plurality of cases according to All Patient Refined Diagnosis Related Groups (APR-DRG) classification, All Patient DRG classification, or All Patient Severity DRG classification.

10. The method of claim 1, further comprising presenting results to a user, wherein said results include said performance profile of said entity as compared to said equivalent performance profile of said virtual peer in a plurality of classes for a plurality of measures at a plurality of levels.

11. A computer readable medium carrying computer executable program instructions operable to implement a method for peer-profiling performance of an entity, wherein said computer executable program instructions comprise:

code for generating a performance profile of said entity, wherein said entity is representative of one or more individuals;

code for constructing a virtual peer having an equivalent performance profile; and

code for comparing said performance profile of said entity with said equivalent performance profile of said virtual peer.

12. The computer readable medium of claim 11, further comprising:

code for obtaining data on a plurality of cases for which said entity is responsible within a specified time period at an organization; and

code for classifying said plurality of cases into a plurality of groups according to an industry standard.

13. The computer readable medium of claim 12, wherein said industry standard is representative of All Patient Refined Diagnosis Related Groups (APR-DRG) classification, All Patient DRG classification, or All Patient Severity DRG classification.

14. The computer readable medium of claim 11, further comprising:

code for determining entity averages for a plurality of measures based on a group of cases that meet a set of criteria and for which said entity is responsible within a specified time period at an organization; and

code for determining peer averages for said plurality of measures based on a composite of cases selectively obtained from a data source, wherein said composite of cases is selected to match said group of cases.

15. The computer readable medium of claim 11, further comprising:

code for presenting results to a user, wherein said results include said performance profile of said entity as compared to said equivalent performance profile of said virtual peer in a plurality of classes for a plurality of measures at a plurality of levels.

16. A computer system for peer-profiling performance of an entity, comprising:

a server configured to receive user requests over a network, wherein, in response to a query on said entity, said server is operable to;

generate a performance profile of said entity, wherein said entity is representative of one or more individuals;

construct a virtual peer having an equivalent performance profile; and

compare said performance profile of said entity with said equivalent performance profile of said virtual peer.

17. The computer system of claim 16, further comprising:

a data repository communicatively coupled to said server, wherein said server is further operable to access said data repository and obtain data on a plurality of cases for which said entity is responsible within a specified time period at an organization.

18. The computer system of claim 17, wherein said server is further operable to classify said plurality of cases into a plurality of groups according to an industry standard.

19. The computer system of claim 16, wherein said server is further operable to:

determine entity averages for a plurality of measures based on a group of cases that meet a set of criteria and for which said entity is responsible within a specified time period at an organization; and

determine peer averages for said plurality of measures based on a composite of cases selectively obtained from a data source, wherein said composite of cases is selected to match said group of cases.

20. The computer system of claim 16, further comprising:

a client communicatively coupled to said server via said network, wherein said server is further operable to present results over said network to a user at said client, wherein said results include said performance profile of said entity as compared to said equivalent performance profile of said virtual peer in a plurality of classes for a plurality of measures at a plurality of levels.