Risk management system for use with cardiac patients

• US 5,276,612 A
• Filed: 09/21/1990
• Issued: 01/04/1994
• Est. Priority Date: 09/21/1990
• Status: Expired due to Term

• Current Assignee: New England Medical Center Hospitals, Inc.
• Original Assignee: New England Medical Center Hospitals, Inc.
• Inventors: Selker, Harry P.
• Primary Examiner(s): Hayes, Gail O.
• Application Number:
  US07/586,252
• Time in Patent Office: 1,201 Days
• Field of Search: 364/413.06, 128/668, 395/100, 395/101, 395/149
• US Class Current: 600/523
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: Y10S 128/92 Computer assisted medical diagnostics

Abstract

A risk management system for use in a health care facility which receives patients who may be experiencing cardiac problems, the system including a first input port for receiving inputs derived from electrocardiograph measurements of a patient; a predictive instrument for using the inputs to compute a probability of the patient having a particular heart condition; a printer for generating a risk management form reporting the computed probability for the patient as well as other clinical and ECG-related observations for the patient, the form also containing categories requiring a person who is evaluating the patient to enter additional information relating to the evaluation of the patient, the computed probability triggering the printer to generate the form only when the computed probability falls within a preselected range which is less than the total range of possible values for the computed probability.

Claims

1. A risk management system for use in a health care facility which receives patients who may be experiencing cardiac problems, the system comprising;

a first input port receiving inputs derived from electrocardiograph measurements of a selected one of said patients;

a second input port receiving user entered information about the selected patient;

a predictive instrument using the inputs to compute a probability of the selected patient having a particular heart condition;

a printer means for generating a risk management form reporting the computed probability as well as other clinical and ECG-related observations for the selected patient, said printer means programmed to also print a set of uncompleted categories on said form, said set of uncompleted categories being the same regardless of what user entered information has been provided prior to generating said form, said uncompleted categories to be filled in with additional information relating to the evaluation of the selected patient by persons who evaluate the selected patient and said set of uncompleted categories selected to enhance medical evaluations of said patients when completed by said persons subsequent to the printing of said form, said predictive instrument automatically triggering said printer means to generate said form when and only when said computed probability falls within a preselected range which is less than the total range of possible values for said computed probability.

2. The system of claim 1 further comprising:

an electrocardiograph for generating an electrocardiograph waveform for the patient; and

a waveform analyzer for analyzing the electrocardiograph waveform and generating the electrocardiograph-derived inputs.

3. The system of claim 1 or 2 wherein said particular heart condition is acute cardiac ischemia.

4. The system of claim 1 wherein the preselected range includes all possible probabilities above a preselected positive non zero lower limit.

5. The system of claim 1 wherein the preselected range only extends from about 5% to about 55%.

6. The system of claim 3 wherein said predictive instrument uses an empirically based mathematical model of actual clinical experience to compute the probability of acute cardiac ischemia.

7. The system of claim 6 wherein said predictive instrument uses a regression model to compute the probability of acute cardiac ischemia.

8. The system of claim 7 wherein said predictive instrument uses a multivariate logistic regression model to compute the probability of acute cardiac ischemia.

9. The system of claim 1 further comprising a second input port for receiving inputs relating to clinical data for the patient and wherein said predictive instrument uses said clinical data inputs along with said electrocardiograph-derived inputs to compute the probability of the patient having a particular heart condition.

10. The system of claim 1 further comprising means for enabling a user to cause said printer to generate said form independent of what the value of said computed probability is.

11. A method for managing risk in a health care environment which receives patients who may be experiencing cardiac problems, the method comprising:

using an electrocardiograph to measure a condition of a selected one of said patients;

supplying other information about the selected patient;

generating input signals from electrocardiograph measurements of the patient'"'"'s condition;

computing from the input signals and from at least some of the other information supplied for the selected patient a probability that the selected patient is experiencing a particular heart condition;

automatically generating a risk management form reporting the computed probability as well as other clinical and ECG-related observations for the selected patient, said form also containing a set of uncompleted categories, said set of uncompleted categories being the same regardless of which of said patients is the selected patient and regardless of said other information that has been supplied prior to generating said form, said uncompleted categories to be filled in with additional information related to the evaluation of the select ed patient by persons who evaluate the selected patient and said set of uncompleted categories selected to enhance a medical evaluation of said patients when completed by said persons subsequent to the printing of said form, said form being automatically generated when and only when said computed probability falls within a preselected range which is less than the total range of possible values for said computed probability; and

requiring said person to complete the uncompleted categories on said form as part of completing a medical evaluation of the selected patient.

12. The method of claim 11 further comprising:

generating an electrocardiograph waveform for the patient; and

using a waveform analyzer to analyze the electrocardiograph waveform and generate the input signals.

13. The method of claim 12 wherein said particular heart condition is acute cardiac ischemia.

14. The method of claim 13 wherein the preselected range includes all possible probabilities above a preselected positive non zero lower limit.

15. The method of claim 14 wherein the preselected range only extends from about 5% to abut 55%.

16. The method of claim 13 wherein an empirically based mathematical model of actual clinical experience is used to compute the probability of acute cardiac ischemia.

17. The method of claim 16 wherein a regression model is used to compute the probability of acute cardiac ischemia.

18. The method of claim 17 wherein a multivariate logistic regression model is used to compute the probability of acute cardiac ischemia.

19. The method of claim 12 wherein the computing step also uses clinical data for the patient along with said to compute the probability of the patient having a particular heart condition.