CA2371007A1 - Method of grouping and analyzing clinical risks, and system therefor - Google Patents
Method of grouping and analyzing clinical risks, and system therefor Download PDFInfo
- Publication number
- CA2371007A1 CA2371007A1 CA002371007A CA2371007A CA2371007A1 CA 2371007 A1 CA2371007 A1 CA 2371007A1 CA 002371007 A CA002371007 A CA 002371007A CA 2371007 A CA2371007 A CA 2371007A CA 2371007 A1 CA2371007 A1 CA 2371007A1
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- Prior art keywords
- disease
- episode
- severity
- illness
- categories
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Classifications
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q10/00—Administration; Management
- G06Q10/10—Office automation; Time management
-
- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
- G06Q40/02—Banking, e.g. interest calculation or account maintenance
-
- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
- G06Q40/08—Insurance
-
- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
- G16H10/40—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for data related to laboratory analysis, e.g. patient specimen analysis
-
- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
- G16H10/60—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records
-
- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
- G16H50/30—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for calculating health indices; for individual health risk assessment
-
- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
- G16H50/70—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for mining of medical data, e.g. analysing previous cases of other patients
Abstract
A comprehensive set of risk groups explicitly identifies groups of individuals with multiple interacting co-morbid conditions, and which explicitly identifies the severity of illness level. This allows accurate prediction of future health care resource needs of an entire population, while simultaneously helping the health care provider isolate problems to identify changes in care to reduce costs and improve quality.
Claims (23)
1. A method of creating a classification system for medical care, characterized by:
a) obtaining a set of medical care codes;
b) categorizing the medical care codes into major disease categories;
c) categorizing the medical care codes into episode disease categories based on the severity and persistence of the disease, and assigning each episode disease category to a major disease category; and d) sub-dividing at least some of the episode disease categories by severity of illness.
a) obtaining a set of medical care codes;
b) categorizing the medical care codes into major disease categories;
c) categorizing the medical care codes into episode disease categories based on the severity and persistence of the disease, and assigning each episode disease category to a major disease category; and d) sub-dividing at least some of the episode disease categories by severity of illness.
2. The method of claim 1, further characterized by defining a set of severity of illness levels for each episode disease category.
3. The method of any of claims 1 through 2, wherein at least some of the episode disease categories represent chronic conditions, and further characterized in that only the chronic episode disease categories are sub-divided by severity of illness.
4. The method of any of claims 1 through 3, further characterized by defining a severity of illness leveling matrix for adjusting the severity of illness level for each episode disease category based on the nature and timing of treatment for each episode disease category.
5. The method of any of claims 1 through 4, further characterized by:
a) providing a second set of medical care codes;
b) categorizing the medical care codes in the second set into episode procedure categories;
wherein the severity of illness leveling matrix takes account of the episode procedure categories in adjusting the severity of illness level for each episode disease category.
a) providing a second set of medical care codes;
b) categorizing the medical care codes in the second set into episode procedure categories;
wherein the severity of illness leveling matrix takes account of the episode procedure categories in adjusting the severity of illness level for each episode disease category.
6. The method of claim 5, further characterized by creating episode disease categories which are indicated by episode procedure categories.
7. The method any of claims 1 through 6, further characterized by defining criteria for aggregating the episode disease categories and severity of illness levels to assign an overall clinical risk group and severity of illness rating to an individual patient.
8. The method any of of claims 1 through 7, further characterized by defining a set of selection criteria for selecting a primary chronic disease from the episode disease categories for each major disease category.
9. The method of claim 8, wherein the selection criteria for selecting the primary chronic disease are further characterized by:
a) ranking the episode disease categories in each major disease category by severity;
b) adjusting the ranking based on the presence and severity of episode disease categories in other major disease category;
c) selecting as the primary chronic disease the highest adjusted rank episode disease category in each major disease.
a) ranking the episode disease categories in each major disease category by severity;
b) adjusting the ranking based on the presence and severity of episode disease categories in other major disease category;
c) selecting as the primary chronic disease the highest adjusted rank episode disease category in each major disease.
10. The method of any of claims 7 through 9, wherein the criteria assigning the overall clinical risk group are further characterized by:
a) defining criteria for a series of risk groups ranked in order of declining severity;
b) comparing the primary chronic diseases to the criteria for each risk group, and assigning the most severe clinical risk group for which the criteria are met.
a) defining criteria for a series of risk groups ranked in order of declining severity;
b) comparing the primary chronic diseases to the criteria for each risk group, and assigning the most severe clinical risk group for which the criteria are met.
11. The method of any of claims 7 through 10, further characterized in that the clinical risk groups are:
a) catastrophic conditions;
b) dominant and metastatic malignancies;
c) dominating chronic disease three or more organ systems;
d) significant chronic disease in multiple organ systems;
e) single dominant or moderate chronic disease;
f) minor chronic disease in multiple organ systems;
g) single minor chronic disease;
h) history of significant acute disease; and i) healthy.
a) catastrophic conditions;
b) dominant and metastatic malignancies;
c) dominating chronic disease three or more organ systems;
d) significant chronic disease in multiple organ systems;
e) single dominant or moderate chronic disease;
f) minor chronic disease in multiple organ systems;
g) single minor chronic disease;
h) history of significant acute disease; and i) healthy.
12. The method of any of claims 7 through 11, further characterized by defining criteria for aggregating the clinical risk group and severity of illness rating to assign at least one aggregated clinical risk group and severity of illness rating to a group of patients.
13. A method of applying the classification system of any of claims 1 through 12, characterized by:
a) obtaining historical care data for an individual;
b) determining the episode disease categories for the individual;
c) adjusting the episode disease categories for the individual based on the nature and temporal relationships of the episode disease categories experienced by the individual.
a) obtaining historical care data for an individual;
b) determining the episode disease categories for the individual;
c) adjusting the episode disease categories for the individual based on the nature and temporal relationships of the episode disease categories experienced by the individual.
14. The method of claim 13, further characterized in that the adjustment step includes deleting episode disease categories when the temporal relationship between events implies that the disease indicated by an episode disease category has likely been eliminated by subsequent treatment.
15. The method of any of claims 13 through 14, further characterized in that the adjustment step includes adding episode disease categories when the presence of multiple episode disease categories implies the presence of an underlying episode disease category.
16. The method of any of claims 13 through 15, further characterized by assigning a clinical risk group to the individual based on the adjusted episode disease categories experienced by the individual.
17. The method of claim 16, further characterized by:
a) identifying from adjusted episode disease categories the primary chronic disease in each major disease categories; and b) determining the clinical risk group based on the primary chronic diseases.
a) identifying from adjusted episode disease categories the primary chronic disease in each major disease categories; and b) determining the clinical risk group based on the primary chronic diseases.
18. The method of any of claims 13 through 17, further characterized by:
a) determining the severity of illness level for each episode disease category experienced by the individual;
b) setting an initial severity of illness level for each major disease category to the severity of illness level for the primary chronic disease for that major disease category;
c) adjusting the severity of illness level based on the nature, temporal relationships and severity of illness levels of the episode disease categories experienced by the individual; and d) assigning an overall severity of illness for the individual based on the adjusted severity of illness levels for the major disease categories experienced by the individual.
a) determining the severity of illness level for each episode disease category experienced by the individual;
b) setting an initial severity of illness level for each major disease category to the severity of illness level for the primary chronic disease for that major disease category;
c) adjusting the severity of illness level based on the nature, temporal relationships and severity of illness levels of the episode disease categories experienced by the individual; and d) assigning an overall severity of illness for the individual based on the adjusted severity of illness levels for the major disease categories experienced by the individual.
19. The method of any of claims 13 through 18, further characterized by:
a) using the criteria for aggregating the clinical risk groups to aggregate the individuals clinical risk group into an aggregated clinical risk group;
b) using the criteria for aggregating severity of illness to determine the severity of illness of the aggregated clinical risk group.
a) using the criteria for aggregating the clinical risk groups to aggregate the individuals clinical risk group into an aggregated clinical risk group;
b) using the criteria for aggregating severity of illness to determine the severity of illness of the aggregated clinical risk group.
20. The method of claim 19, further characterized by repeating steps (b) and (c) in claim 19 to further aggregate the aggregated clinical risk groups.
21. The method any of claims 13 through 20, further characterized by:
a) repeating steps (a) through (c) for a plurality of individuals to assign a historical clinical risk group representative of what their clinical risk group would have been at a prior time;
b) analyzing the historical care data for a pre-determined time period after the prior time to determine the average cost of providing health care to all individuals in each historical clinical risk group during the time period; and c) projecting future costs for the plurality of individuals by weighting the average costs for each historical risk group by the number of people currently in each clinical risk groups.
a) repeating steps (a) through (c) for a plurality of individuals to assign a historical clinical risk group representative of what their clinical risk group would have been at a prior time;
b) analyzing the historical care data for a pre-determined time period after the prior time to determine the average cost of providing health care to all individuals in each historical clinical risk group during the time period; and c) projecting future costs for the plurality of individuals by weighting the average costs for each historical risk group by the number of people currently in each clinical risk groups.
22. Computer storage media characterized by containing software which, when executed by a computer, will cause the computer to implement the method of any of claims through 21.
23. A computer having a central processing unit, characterized in that the central processing unit is programmed to apply the method of any of claims 1 through 21.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US09/302336 | 1999-04-29 | ||
| US09/302,336 US7127407B1 (en) | 1999-04-29 | 1999-04-29 | Method of grouping and analyzing clinical risks, and system therefor |
| PCT/US1999/017023 WO2000067189A1 (en) | 1999-04-29 | 1999-07-28 | Method of grouping and analyzing clinical risks, and system therefor |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CA2371007A1 true CA2371007A1 (en) | 2000-11-09 |
| CA2371007C CA2371007C (en) | 2010-07-13 |
Family
ID=23167330
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA2371007A Expired - Lifetime CA2371007C (en) | 1999-04-29 | 1999-07-28 | Method of grouping and analyzing clinical risks, and system therefor |
Country Status (6)
| Country | Link |
|---|---|
| US (3) | US7127407B1 (en) |
| EP (1) | EP1185947A1 (en) |
| JP (1) | JP2002543534A (en) |
| AU (1) | AU5132999A (en) |
| CA (1) | CA2371007C (en) |
| WO (1) | WO2000067189A1 (en) |
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| US8447624B2 (en) | 2000-12-04 | 2013-05-21 | 3M Innovative Properties Company | Methods for managing infection risk incident to surgical procedures in health care provider environments |
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| US8793146B2 (en) * | 2001-12-31 | 2014-07-29 | Genworth Holdings, Inc. | System for rule-based insurance underwriting suitable for use by an automated system |
| US8005693B2 (en) | 2001-12-31 | 2011-08-23 | Genworth Financial, Inc. | Process for determining a confidence factor for insurance underwriting suitable for use by an automated system |
| US7899688B2 (en) | 2001-12-31 | 2011-03-01 | Genworth Financial, Inc. | Process for optimization of insurance underwriting suitable for use by an automated system |
| US7818186B2 (en) | 2001-12-31 | 2010-10-19 | Genworth Financial, Inc. | System for determining a confidence factor for insurance underwriting suitable for use by an automated system |
| US7844477B2 (en) | 2001-12-31 | 2010-11-30 | Genworth Financial, Inc. | Process for rule-based insurance underwriting suitable for use by an automated system |
| US20040167719A1 (en) * | 2002-08-06 | 2004-08-26 | Jonathan Jones | System and method for evaluating the cost-effectiveness of providing growth hormone replacement therapy |
| US20140200907A1 (en) * | 2013-01-16 | 2014-07-17 | American Health Data Institute, Inc. | Method of optimizing healthcare services consumption |
| US11335446B2 (en) | 2002-12-06 | 2022-05-17 | Quality Healthcare Intermediary, Llc | Method of optimizing healthcare services consumption |
| US7383239B2 (en) | 2003-04-30 | 2008-06-03 | Genworth Financial, Inc. | System and process for a fusion classification for insurance underwriting suitable for use by an automated system |
| US7813945B2 (en) | 2003-04-30 | 2010-10-12 | Genworth Financial, Inc. | System and process for multivariate adaptive regression splines classification for insurance underwriting suitable for use by an automated system |
| US7801748B2 (en) | 2003-04-30 | 2010-09-21 | Genworth Financial, Inc. | System and process for detecting outliers for insurance underwriting suitable for use by an automated system |
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| JP6101563B2 (en) * | 2013-05-20 | 2017-03-22 | 株式会社日立製作所 | Information structuring system |
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| CA2965499A1 (en) * | 2014-10-24 | 2016-05-28 | Qualdocs Medical, Llc | Systems and methods for clinical decision support and documentation |
| CN106656932B (en) * | 2015-11-02 | 2020-03-20 | 阿里巴巴集团控股有限公司 | Service processing method and device |
| JP6861481B2 (en) | 2016-07-06 | 2021-04-21 | オムロンヘルスケア株式会社 | Risk analysis system and risk analysis method |
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-
1999
- 1999-04-29 US US09/302,336 patent/US7127407B1/en not_active Expired - Lifetime
- 1999-07-28 CA CA2371007A patent/CA2371007C/en not_active Expired - Lifetime
- 1999-07-28 JP JP2000615956A patent/JP2002543534A/en active Pending
- 1999-07-28 WO PCT/US1999/017023 patent/WO2000067189A1/en active Application Filing
- 1999-07-28 EP EP99935965A patent/EP1185947A1/en not_active Ceased
- 1999-07-28 AU AU51329/99A patent/AU5132999A/en not_active Abandoned
-
2006
- 2006-08-21 US US11/465,901 patent/US8571892B2/en not_active Expired - Fee Related
-
2013
- 2013-09-24 US US14/035,103 patent/US20140025395A1/en not_active Abandoned
Also Published As
| Publication number | Publication date |
|---|---|
| WO2000067189A1 (en) | 2000-11-09 |
| JP2002543534A (en) | 2002-12-17 |
| EP1185947A1 (en) | 2002-03-13 |
| CA2371007C (en) | 2010-07-13 |
| US7127407B1 (en) | 2006-10-24 |
| AU5132999A (en) | 2000-11-17 |
| US8571892B2 (en) | 2013-10-29 |
| US20060287888A1 (en) | 2006-12-21 |
| US20140025395A1 (en) | 2014-01-23 |
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| EEER | Examination request | ||
| MKEX | Expiry |
Effective date: 20190729 |