System and method for peer-profiling individual performance

• US 8,082,172 B2
• Filed: 04/21/2006
• Issued: 12/20/2011
• 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
• Primary Examiner(s): Boswell, Beth V
• Assistant Examiner(s): DELICH, STEPHANIE ZAGARELLA
• Application Number:
  US11/408,560
• Publication Number:
  US 20060241974A1
• Time in Patent Office: 2,069 Days
• Field of Search: 705/2, 705/7.39, 705/7.42
• US Class Current: 705/7.39
• 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:

at a server computer;

in response to a request from a client computer communicatively coupled to the server computer, generating a performance profile of said entity, wherein said entity is representative of one or more individuals, wherein said performance profile comprises a plurality of measures, wherein each applicable measure of said plurality comprises an entity average determined based on a group of cases that meet a set of criteria specific to said applicable measure, wherein said entity is responsible for said group of cases, and wherein if a case for which said entity is responsible does not meet said set of criteria specific to said applicable measure, it is not included in said group of cases;

constructing a virtual peer having an equivalent performance profile with respect to said applicable measure, wherein said constructing step further comprises selecting, from a plurality of peer cases, a composite of cases that also meet said set of criteria specific to said applicable measure, wherein if a peer case does not meet said set of criteria specific to said applicable measure, it is not included in said composite of cases, wherein said group of cases is a subset of a plurality of cases for which said entity is responsible, wherein said composite of cases is a subset of said plurality of peer cases for which two or more peers of said entity are responsible, and wherein both subsets meet said set of criteria specific to said applicable measure, effectuating a meaningful comparison between said entity and said peers of said entity, wherein said equivalent performance profile for said virtual peer comprises a peer average determined based on said composite of cases, and wherein said peer average is specific with respect to said applicable measure;

comparing said performance profile of said entity with said equivalent performance profile of said virtual peer, including;

determining a distribution ratio of said group of cases for which said entity is responsible with regard to said plurality of measures; and

configuring said composite of cases over said distribution ratio; and

returning results to said client computer.

2. The method of claim 1, wherein said entity is responsible for said group of cases within a specified time period.

3. The method of claim 2, wherein said composite of cases is selected to match said group of cases over said specified time period.

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 applicable measure; and

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

5. The method of claim 1, wherein said plurality of peer cases is from a data source associated with a hospital, a hospital system, a state agency, a national agency, an international agency, or an independent agency.

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

7. 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.

8. The method of claim 7, 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.

9. The method of claim 1, further comprising presenting said results to a user at said client computer, 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 said plurality of measures at a plurality of levels.

10. A computer program product comprising at least one non-transitory computer readable medium storing program instructions translatable by at least one processor to perform:

generating, at a server computer, a performance profile of said entity, wherein said entity is representative of one or more individuals, wherein said performance profile comprises a plurality of measures, wherein each applicable measure of said plurality comprises an entity average determined based on a group of cases that meet a set of criteria specific to said applicable measure, and wherein said entity is responsible for said group of cases, and wherein if a case for which said entity is responsible does not meet said set of criteria specific to said applicable measure, it is not included in said group of cases;

constructing a virtual peer having an equivalent performance profile with respect to said applicable measure, wherein said constructing step further comprises selecting, from a plurality of peer cases, a composite of cases that also meet said set of criteria specific to said applicable measure, wherein if a peer case does not meet said set of criteria specific to said applicable measure, it is not included in said composite of cases, wherein said group of cases is a subset of a plurality of cases for which said entity is responsible, wherein said composite of cases is a subset of said plurality of peer cases for which two or more peers of said entity are responsible, and wherein both subsets meet said set of criteria specific to said applicable measure, effectuating a meaningful comparison between said entity and said peers of said entity, wherein said equivalent performance profile for said virtual peer comprises a peer average determined based on said composite of cases, and wherein said peer average is specific with respect to said applicable measure; and

comparing said performance profile of said entity with said equivalent performance profile of said virtual peer, including;

determining a distribution ratio of said group of cases for which said entity is responsible with regard to said plurality of measures; and

configuring said composite of cases over said distribution ratio.

11. The computer program product of claim 10, wherein the non-transitory computer readable medium further comprises instructions translatable by the at least one processor to perform:

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

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

12. The computer program product of claim 11, 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.

13. The computer program product of claim 10, wherein the non-transitory computer readable medium further comprises instructions translatable by the at least one processor to perform:

presenting results to a user at a client computer coupled to said server computer, 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 said plurality of measures at a plurality of levels.

14. 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, wherein said performance profile comprises a plurality of measures, wherein each applicable measure of said plurality comprises an entity average determined based on a group of cases that meet a set of criteria specific to said applicable measure, and wherein said entity is responsible for said group of cases, and wherein if a case for which said entity is responsible does not meet said set of criteria specific to said applicable measure, it is not included in said group of cases;

construct a virtual peer having an equivalent performance profile with respect to said applicable measure, wherein said constructing step further comprises selecting, from a plurality of peer cases, a composite of cases that also meet said set of criteria specific to said applicable measure, wherein if a peer case does not meet said set of criteria specific to said applicable measure, it is not included in said composite of cases, wherein said group of cases is a subset of a plurality of cases for which said entity is responsible, wherein said composite of cases is a subset of said plurality of peer cases for which two or more peers of said entity are responsible, and wherein both subsets meet said set of criteria specific to said applicable measure, effectuating a meaningful comparison between said entity and said peers of said entity, wherein said equivalent performance profile for said virtual peer comprises a peer average determined based on said composite of cases, and wherein said peer average is specific with respect to said applicable measure; and

compare said performance profile of said entity with said equivalent performance profile of said virtual peer, including;

determining a distribution ratio of said group of cases for which said entity is responsible with regard to said plurality of measures; and

configuring said composite of cases over said distribution ratio.

15. The computer system of claim 14, 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.

16. The computer system of claim 15, wherein said server is further operable to classify said plurality of cases into a plurality of groups according to an industry standard.

17. The computer system of claim 14, 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 said plurality of measures at a plurality of levels.