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Method of modifying comparable health care services

  • US 5,724,379 A
  • Filed: 12/21/1994
  • Issued: 03/03/1998
  • Est. Priority Date: 05/01/1990
  • Status: Expired due to Fees
First Claim
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1. A method of modifying health care services rendered to a population of patients by a plurality of providers of health care services, said method comprising:

  • a. dividing human diseases evident from predetermined diagnoses and procedures into at least four groups, namely, acute diseases, chronic diseases, mental health, and pregnancy and further dividing the groups into orders of clinical complexity ranging from less to more clinically complex;

    b. linking each patient of the population to the patient'"'"'s respective records in a data base of health care experience information containing records of both inpatient and outpatient services including diagnoses and procedures for individual patient'"'"'s multiple episodes of illness;

    c. assigning each patient a clinical complexity rating by comparing the various diagnoses and procedures linked to each patient with the ordered groups of clinical complexity into which such diagnoses and procedures were previously grouped;

    d. computer processing the data base of health care experience information to determine the extent to which the ordered groups of clinical complexity systematically relate to indicia of quality and utilization of the services rendered to the patients so that the indicia of quality and utilization can be compared independently of the ordered groups'"'"' clinical complexity;

    e. computer processing comparisons of health care services rendered by different providers to different groups of patients in the population by using the systematic relationship between the groups of clinical complexity and the indicia of quality and utilization of health care services to reveal comparative clinical efficiencies of the different providers;

    f. using the comparative provider clinical efficiencies to increase the number of the comparably more efficient health care services for patients in the population and to decrease the number of comparably less efficient health care services for patients in the population, thereby increasing the clinical efficiency of the overall rendering of health care services to the population; and

    g. completing the modification of health care services using the comparative provider clinical efficiencies so that the data base of health care experience information is modified to reflect a different systematic relationship between the groups of clinical complexity and the indicia of quality and utilization of health care services indicative of increased overall clinical efficiency of the health care services rendered to the population.

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