METHOD OF GROUPING AND ANALYZING CLINICAL RISKS
First Claim
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1. A method of rating the nature and severity of health care requirements for an individual, including:
- (a) providing a computer system storing a set of medical disease codes, wherein the medical disease codes are categorized into major disease categories, wherein the medical disease codes in each major disease category are categorized into episode disease categories based on severity of health care requirements, wherein at least some of the episode disease categories are sub-divided by severity of illness level by using severity of illness rules, and wherein the computer system further stores overall clinical risk group criteria for assigning an overall clinical risk group to an individual patient, where the overall clinical risk group criteria takes into account the episode disease categories and severity of illness levels;
(b) obtaining historical care data for an individual;
(c) determining the episode disease categories for the individual;
(d) assigning severity levels to the episode disease categories for the individual; and
(e) assigning an overall clinical risk group to an individual based on the overall clinical risk group criteria.
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Abstract
A method of creating a classification system for rating the nature and severity of health care requirements, including obtaining a set of medical disease codes, categorizing the medical disease codes into major disease categories, and categorizing the medical disease codes in each major disease category into episode disease categories based on severity.
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Citations
38 Claims
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1. A method of rating the nature and severity of health care requirements for an individual, including:
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(a) providing a computer system storing a set of medical disease codes, wherein the medical disease codes are categorized into major disease categories, wherein the medical disease codes in each major disease category are categorized into episode disease categories based on severity of health care requirements, wherein at least some of the episode disease categories are sub-divided by severity of illness level by using severity of illness rules, and wherein the computer system further stores overall clinical risk group criteria for assigning an overall clinical risk group to an individual patient, where the overall clinical risk group criteria takes into account the episode disease categories and severity of illness levels; (b) obtaining historical care data for an individual; (c) determining the episode disease categories for the individual; (d) assigning severity levels to the episode disease categories for the individual; and (e) assigning an overall clinical risk group to an individual based on the overall clinical risk group criteria. - View Dependent Claims (2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19)
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8. The method of claim 8, wherein the severity of illness rules adjust the severity of illness level for each episode disease category based on the recency of other episode disease categories.
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20. A computer system for rating the nature and severity of health care requirements for an individual, including:
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(a) a storage device storing; (i) a set of medical disease codes, wherein the medical disease codes are categorized into major disease categories, wherein the medical disease codes in each major disease category are categorized into episode disease categories based on severity of health care requirements, wherein at least some of the episode disease categories are sub-divided by severity of illness level by using severity of illness rules, and wherein the computer system further stores overall clinical risk group criteria for assigning an overall clinical risk group to an individual patient, where the overall clinical risk group criteria takes into account the episode disease categories and severity of illness levels; and (ii) historical care data for an individual; and (b) a processing unit configured for; (i) determining the episode disease categories for the individual; (ii) assigning severity levels to the episode disease categories for the individual; and (iii) assigning an overall clinical risk group to an individual based on the overall clinical risk group criteria. - View Dependent Claims (21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38)
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Specification