Method for measuring health care quality

• US 8,392,215 B2
• Filed: 03/22/2012
• Issued: 03/05/2013
• Est. Priority Date: 04/20/2006
• Status: Active Grant

• Current Assignee: Jack Joseph Tawil
• Original Assignee: Jack Joseph Tawil
• Inventors: Tawil, Jack Joseph
• Primary Examiner(s): RANGREJ, SHEETAL
• Application Number:
  US13/426,937
• Publication Number:
  US 20120179487A1
• Time in Patent Office: 348 Days
• Field of Search: 705 2- 3
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• 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 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: Y02A 90/10 Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation

Abstract

A method is presented for measuring the recovery of a medical treatment provider'"'"'s patients from a given medical condition. During treatment and recovery, a patient periodically takes a survey to report the current intensity of the signs and symptoms caused by his/her medical condition. The patient also assigns a weight to each sign/symptom, indicating the relative intensity of his/her desire to eliminate it. The product of the intensity of a sign or symptom and its corresponding weight measures the diminishment of quality of life. An outcomes measure, measurable in quality-adjusted life-years, compares a patient'"'"'s predicted recovery, which is rendered by an independent source at the time the patient'"'"'s diagnosis is determined, with the patient'"'"'s actual recovery. Outcomes measures for a provider'"'"'s patients with a given medical condition and with similar predicted recoveries are combined to produce an unbiased, risk-adjusted outcomes index that can be compared with that of other providers.

Claims

1. A computerized method for measuring the performance of a medical treatment provider, comprising the steps of:

a) providing a processor;

a memory in communication with said processor;

the memory including program code executable by said processor;

data entry means; and

data for a database;

b) providing a processing system, comprising;

i. said database, comprising;

1. data originating from enrollment of insured patients;

2. surveys of said insured patients;

3. medical data, including data relevant to determining prognoses of said insured patients;

4. data originating from vendors providing;

diagnostic codes and their descriptions for each of a plurality of diagnoses;

procedure codes and their descriptions for each of a plurality of procedures; and

death notices to include the insured population; and

5. historical patient data relating to quality of life, comprising patient outcomes ratings by diagnostic code or type of illness or injury, said outcomes ratings based on a prognosis rating versus an outcomes measure of prior patients;

ii. first processing means for producing for an insured patient a treatment plan that specifies the identity of said insured patient, at least one procedure to be provided, and a prognosis rating;

iii. second processing means for producing a treatment record that specifies at least one procedure actually provided to said insured patient;

iv. third processing means for calculating at least one recovery score for said insured patient and modifying said outcomes index of said medical treatment provider to include said recovery score of said insured patient; and

c) accessing said database to add said insured patient'"'"'s said prognosis rating, said recovery score and said death notice, if any; and

said medical treatment provider'"'"'s said modified outcomes index, whereby the improvement comprises the ability to compare the outcomes index of one medical treatment provider with the outcomes index of other medical treatment providers with respect to a given diagnosis and for patients with comparable prognosis ratings;

d) producing a set of reference recovery functions (RRFs) for each of a plurality of types of illnesses or injuries from historical patient data relating to quality of life;

e) generating a predicted recovery score for a patient of said medical treatment provider by combining said set of RRFs and the prognosis rating of said patient for an episode of illness or injury, and where said prognosis rating is produced independently of said medical treatment provider, whereby said independently produced prognosis rating can provide an unbiased prognosis rating;

f) administering a survey of the signs and symptoms of said patient, wherein;

each said sign or symptom is caused by said episode of illness or injury;

each said sign or symptom is assigned a severity score corresponding to said patient'"'"'s perception of the severity of said sign or symptom; and

each said sign or symptom is assigned a weight corresponding to the relative intensity with which said patient desires to eliminate said sign or symptom;

g) calculating a survey score, comprising the normalized sum of the products of said severity scores and their corresponding said weights, whereby said survey score is a measure of quality-of-life status;

h) generating a personal recovery function by combining with said set of RRFs a plurality of said patient'"'"'s survey scores obtained at different times, wherein said plurality of said patient'"'"'s survey scores constitutes a survey score set;

i) calculating an actual recovery score from said personal recovery function; and

j) calculating an outcomes measure by combining said predicted recovery score with said actual recovery score.

2. The method as claimed in claim 1, combining the outcomes measures of a plurality of medical treatment provider'"'"'s past patients, said patients falling within a given prognosis rating group and with the same type of illness or injury, to produce an outcomes index, whereby each said outcomes index is a measure of the performance of said medical treatment provider with respect to said prognosis rating group and said type of illness or injury.

3. The method as claimed in claim 2, providing a comparative report wherein the outcomes indices with respect to the same prognosis-rating group for a given type of illness or injury are compared for a plurality of treatment providers.

4. The method as claimed in claim 3, further including a comparative report that includes a value chart depicting each said medical treatment provider'"'"'s outcomes index and treatment cost, whereby the value of treatments administered by said medical treatment providers can be compared.

5. The method as claimed in claim 1, providing the self-administering of said survey by said patient.

6. The method as claimed in claim 1, providing that said RRFs and said severity scores are expressed in units compatible with quality-adjusted life-years.

7. The method as claimed in claim 1, providing generating a set of RRFs for a given type of illness or injury, comprising the steps of rank ordering said survey scores, dividing said survey scores into n groups and statistically fitting at least one mathematical function through said survey scores within each of said n groups, whereby said statistically fitted functions for each said group comprise an RRF;

each RRF is labeled RRF.sub.1 through RRF.sub.n;

RRF.sub.0 is a horizontal line below RRF.sub.1 that corresponds to the state of death; and

RRF.sub.n+1 is a horizontal line above RRF.sub.n that corresponds to the bliss state.

8. The method as claimed in claim 7, providing said steps of rank ordering said survey scores is selected from the methods consisting of rank ordering according to the arithmetic means of said survey score sets and rank ordering by said prognosis ratings associated with said survey score sets, wherein the method of rank ordering according to the means of said survey score sets comprises the following steps:

a) computing the arithmetic mean of each of a plurality of survey score sets associated with a given type of illness or injury;

b) ranking said arithmetic means in ascending order; and

c) dividing said rank ordered arithmetic means into said n groups, where each n corresponds to a prognosis rating group, and n is greater than 2; and

wherein the method of rank ordering by prognosis ratings comprises the following steps;

a) ranking in descending order said survey score sets with respect to their corresponding prognosis ratings; and

b) dividing said rank-ordered prognosis ratings and their corresponding survey score sets into said n groups,

whereby patients facing similar treatment and recovery risks are grouped together as a means for controlling for risk.

9. The method as claimed in claim 7, calculating a predicted recovery score, PS, for said patient whose prognosis rating is x, according to the steps:

calculating the two areas A.sub.k′

+1 and A.sub.k′

, under the two RRF curves RRF.sub.k′

+1 and RRF.sub.k′

, where k′

+1 is the number of the RRF immediately greater than x and k′

is the number of the RRF immediately smaller than or equal to x; and

calculating said predicted recovery score as;

PS=(A.sub.k′

+[x−

int(x)](A.sub.k′

+1−

A.sub.k′

))/S,

where S is the highest possible survey score.

10. The method as claimed in claim 7, providing that said patient'"'"'s survey score sets for a given episode of illness or injury are further subdivided into a plurality of recovery phases, and a mathematical function is statistically fitted through the survey scores within each said recovery phase, whereby said RRF is comprised of a plurality of fitted functions, each said fitted function corresponding to a recovery phase.

11. The method as claimed in claim 7, generating said personal recovery function for said patient, comprising the steps:

a) for each pair of consecutive survey scores taken over time, dividing the line segment connecting said survey scores into sub-segments, as necessary, such that each sub-segment lies wholly between two successive RRFs; and

b) interpolating the path of said personal recovery function between said survey scores such that said personal recovery function passes through both survey scores, the curvature of said personal recovery function is based on the curvatures of the RRFs immediately above and immediately below said line segment, and the curvature characteristics of said personal recovery function are a weighted average of the curvature characteristics of said RRFs, where the weights are inversely proportional to the vertical distances of said line segment from said RRFs.

12. The method as claimed in claim 11, calculating an actual recovery score from said personal recovery function comprising the following steps:

computing the area under each said sub-segment, totaling the areas under all said sub-segments and dividing said total area by the highest possible survey score over the time period encompassing said surveys.

13. The method as claimed in claim 1, updating said outcomes index of a provider to include outcomes measures of more recent patients of said provider and, optionally, dropping outcomes measures of less recent patients with the same type of illness or injury, whereby said outcomes index reflects outcomes based on the latest techniques and technologies used in treating said type of illness or injury.

14. The method as claimed in claim 1, providing the administrator of a health plan with a fully automated process for generating outcomes indices of medical treatment providers who treat members of said health plan, whereby all of the data inputs required to produce outcomes indices are provided in digital form by patients, providers and at least one vendor providing death notices.

15. The method as claimed in claim 1, calculating an outcomes measure as

M.sub.dp*=(.SIGMA..sub.i(RS.sub.idp/years.sub.i))/I,

where RS is the actual recovery score, years.sub.i is the total number of actual years spanned by the recovery scores of the i-th patient, and I is the total number of patients.

16. The method as claimed in claim 1, calculating an outcomes measure as

M.sub.dp.sup.+=(.SIGMA..sub.i(RS.sub.idp/PS.sub.idp))/I,

where RS is the actual recovery score, PS is the predicted recovery score and is the total number of patients.

17. The method as claimed in claim 1, calculating an outcomes measure as

M.sub.dp.sup.#=.SIGMA..sub.iRS.sub.idp/.SIGMA..sub.iPS.sub.idp,

where RS is the actual recovery score and PS is the predicted recovery score.

18. The method as claimed in claim 1, statistically estimating an outcomes measure as

Y.sub.idp=b.sub.0+b.sub.1M.sub.idp*+b.sub.2M.sub.idp.sup.#+b.sub.3PR.sub.idp+b.sub.4 ln Q.sub.idp+u,

where M.sub.dp*=(.SIGMA.sub.i (RS.sub.idp/years.sub.i))/I;

M.sub.dp.sup.#=.SIGMA.sub.i RS.sub.idp/.SIGMA.sub.i PS.sub.idp;

and where PR is the prognosis rating;

ln Q is the natural logarithm of the number of times the provider has treated said type of illness or injury;

RS is the recovery score, PS is the predicted score, years.sub.i is the total number of actual years over which the recovery score is measured, I is the total number of patients being scored, and u is a random error term.

19. The method as claimed in claim 1, statistically estimating for patients with co-morbidities the relationship:

Y=a.sub.0+a.sub.1A+b.sub.1D.sub.1+ . . . +b.sub.nD.sub.n+c.sub.1P.sub.1+ . . . +c.sub.nP.sub.n+d.sub.12D.sub.1D.sub.2+d.sub.13D.sub.1D.sub.3+ . . . +d.sub.ijD.sub.iD.sub.j+ . . . +u,

where A is the age of said patient, D.sub.i (i=1, . . . , n) is a dummy variable with a value of 1 if the illness i is present, 0 if it is not present, D.sub.i D.sub.j is a term for the interaction between illness i and illness j, P.sub.i is the prognosis rating for illness i, where P.sub.i=0 if illness i is not present, Y is the time between the patient'"'"'s original diagnosis and the time of death, a.sub.0, a.sub.1, b.sub.1, . . . , b.sub.n, c.sub.1, . . . , c.sub.n, d.sub.12, d.sub.13 . . . d.sub.ij . . . are parameters to be estimated, and u is a random error term.

20. The method as claimed in claim 1, determining any expected loss of life attributable to a diagnosed illness or injury and its treatment, comprising, for a patient with given risk factors prior to said diagnosed illness or injury, comparing the pre-diagnosis probability distribution of the life expectancy of a population with said risk factors with the probability distribution of the life expectancy for a preferably deceased population with said patient'"'"'s same risk factors, but with no history of said diagnosed illness or injury, whereby any expected loss of life attributable to said diagnosed illness or injury within a given time period can be determined by a person skilled in the art.