Method of modifying comparable health care services
First Claim
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.
9 Assignments
0 Petitions
Accused Products
Abstract
Health care services are made more efficient by comparing health care services from different providers independently of the clinical complexity of treating the diseases of the patients involved. This is accomplished with a computer-aided system using outpatient and inpatient claims data bases containing indicators of clinical conditions, such as age, gender, diagnoses, and procedures used, and including comparison criteria such as utilizations and indicia of quality. The diseases of the patients of the population are grouped by clinical complexity, and the extent of the systematic relationships between the clinical complexity groups and the comparison criteria are analyzed, preferably by regression analysis. With the extent of the systematic relationships to clinical complexity being known, the health care services of different providers are compared for utilization of procedures and indicia of quality, independently of the differing clinical complexity of the patients receiving the services. The health care services rendered are then modified to improve their efficiency, based on the information revealed in the comparisons.
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Citations
5 Claims
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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:
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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. - View Dependent Claims (2, 3)
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4. 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:
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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. using indicia of quality and utilization of services rendered to the patients in the population for comparing the health care services rendered by different providers to the patients in the population; e. 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; f. grouping the patients with their assigned clinical complexity rating into groups receiving health care services from the different providers of the health care services to the patients in the population; g. computer processing the indicia of quality and utilization of the health care services of different providers rendered to different patient groups by using the determined systematic extent of the relationship between the orders of clinical complexity and the indicia of quality and utilization of services to reveal comparative differences between the providers; h. using the comparative differences between the providers to modify the health care services rendered to patients in the population in ways that diminish comparative differences between providers; and i. completing the modification of health care services using the comparative differences between the providers so that the data base of health care experience information is modified to reflect a different systematic extent of relationship between the indicia of quality and utilization of services and the orders of clinical complexity indicative of diminished comparative differences between the providers. - View Dependent Claims (5)
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Specification