US5706441A
Expired / Lapsed
US
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Method and apparatus for objectively monitoring and assessing the performance of health-care providers
Assignee: Cigna Health Corp
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Filing: 1995-06-07
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Granted: 1998-01-06
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Expires: 2015-06-07
Abstract
Abstract A method and apparatus for objectively assessing the complexity of health-care services delivered by each health-care provider within a group of health-care providers to patients serviced by the group of health-care providers. In-patient data records representative of inpatient health-care services performed for patients by health-care providers with the group of health-care providers are stored in a database. Out-patient data records representative of out-patient health-care services performed for patients by health-care providers with the group of health-care providers are also stored in a database. A plurality of sickness episode data records are built by combining information from the in-patient and out-patient data records. Each sickness episode data record corresponds to an individual sickness episode for which health-care services were performed for one of the patients by at least one health-care provider from the group of health-care providers. An objective severity assessment is performed on each of a group of sickness episode data records and, in response said objective severity assessment, an episode severity score is assigned to each sickness episode data record within the group of sickness episode data records. Case load complexity levels are determined for health-care providers within the group of health-care providers from the severity scores. Each case load complexity level determined is representative of a patient case load serviced by a particular health-care provider within the group of health-care providers.
Inventors
- 👤 Edward J. Lockwood
Bibliographic Details
Application Number
—
Jurisdiction
US
Data Source
google_patents
Last Synchronized
2026-11-01 04:53
CPC Classifications
G; G06; G06Q; G06Q30/00; G06Q30/02; G06Q30/06; G16; G16H; G16H10/00; G16H10/60; G16H40/00; G16H40/20
Claims Analysis
Total Claims: 20
Claim 1
Independent Claim
204 words
A computer-implemented method for objectively assessing the complexity of health-care services delivered by each health-care provider within a group of health-care providers to patients serviced by said group of health-care providers, comprising the steps of: (A) providing in-patient data records representative of in-patient health-care services performed for said patients by health-care providers with said group of health-care providers; (B) providing out-patient data records representative of out-patient health-care services performed for said patients by health-care providers with said group of health-care providers; (C) building a plurality of sickness episode data records by combining information from said in-patient and out-patient data records, each sickness episode data record within said plurality of sickness episode data records corresponding to an individual sickness episode for which health-care services were performed for one of said patients by at least one health-care provider from said group of health-care providers; (D) performing an objective severity assessment on a group of sickness episode data records and assigning, in response to said objective severity assessment, an episode severity score to each sickness episode data record within said group of sickness episode data records; and (E) objectively determining case load complexity levels for health-care providers within said group of health-care providers from said severity scores.
Claim 2
Dependent Claim
204 words
A computer-implemented method for objectively assessing the complexity of health-care services delivered by each health-care provider within a group of health-care providers to patients serviced by said group of health-care providers, comprising the steps of: (A) providing in-patient data records representative of in-patient health-care services performed for said patients by health-care providers with said group of health-care providers; (B) providing out-patient data records representative of out-patient health-care services performed for said patients by health-care providers with said group of health-care providers; (C) building a plurality of sickness episode data records by combining information from said in-patient and out-patient data records, each sickness episode data record within said plurality of sickness episode data records corresponding to an individual sickness episode for which health-care services were performed for one of said patients by at least one health-care provider from said group of health-care providers; (D) performing an objective severity assessment on a group of sickness episode data records and assigning, in response to said objective severity assessment, an episode severity score to each sickness episode data record within said group of sickness episode data records; and (E) objectively determining case load complexity levels for health-care providers within said group of health-care providers from said severity scores.
Claim 3
Dependent Claim
38 words
The method of claim 1, wherein said individual sickness episode corresponds to a time period that begins when a patient is injured or begins to feel sick and ends when said patient is no longer injured or sick.
Claim 4
Dependent Claim
32 words
The method of claim 2, wherein said time period begins before any health-care services were performed for said patient by said at least one health-care provider from said group of health-care providers.
Claim 5
Dependent Claim
31 words
The method of claim 1, wherein said patient case load complexity levels determined in step (E) are representative of patients that received a common procedure from one of said health-care providers.
Claim 6
Dependent Claim
54 words
The method of claim 4, wherein a plurality of case load complexity levels are determined in step (E) for each health-care provider within said group of health-care providers, each of said plurality of case load complexity levels corresponding to a different common procedure performed for said patients by said group of health care providers.
Claim 7
Dependent Claim
20 words
The method of claim 4, further comprising the step of: (F) determining a severity comparison benchmark for said common procedure.
Claim 8
Dependent Claim
53 words
The method of claim 6, wherein step (F) comprises the step of determining a plurality of severity comparison benchmarks for said common procedure including first and second severity comparison benchmarks for said common procedure, said first severity comparison benchmark corresponding to a more complex case load level than said second severity comparison benchmark.
Claim 9
Dependent Claim
45 words
The method of claim 6, wherein step (F) comprises the steps of selecting from said case load complexity levels determined in step (E) a plurality of case load complexity levels falling within a predetermined range and averaging said plurality of selected case load complexity levels.
Claim 10
Dependent Claim
49 words
The method of claim 6, wherein step (F) comprises the steps of selecting from said case load complexity levels determined in step (E) a plurality of case load complexity levels falling within a predetermined range and determining a statistical median of said plurality of selected case load complexity levels.
Claim 11
Independent Claim
240 words
An apparatus for objectively assessing the complexity of health-care services delivered by each health-care provider within a group of health-care providers to patients serviced by said group of health-care providers, comprising: (A) a first database for storing in-patient data records representative of in-patient health-care services performed for said patients by health-care providers with said group of health-care providers; (B) a second database for storing out-patient data records representative of out-patient health-care services performed for said patients by health-care providers with said group of health-care providers; (C) an episode builder, coupled to said first and second databases, for building a plurality of sickness episode data records by combining information from said in-patient and out-patient data records, each sickness episode data record within said plurality of sickness episode data records corresponding to an individual sickness episode for which health-care services were performed for one of said patients by at least one health-care provider from said group of health-care providers; (D) a severity assessment means, coupled to said episode builder, for performing an objective severity assessment on a group of sickness episode data records and assigning, in response to said objective severity assessment, an episode severity score to each sickness episode data record within said group of sickness episode data records; and (E) case load assessment means, coupled to said severity assessment means, for objectively determining case load complexity levels for health-care providers within said group of health-care providers from said severity scores.
Claim 12
Independent Claim
240 words
An apparatus for objectively assessing the complexity of health-care services delivered by each health-care provider within a group of health-care providers to patients serviced by said group of health-care providers, comprising: (A) a first database for storing in-patient data records representative of in-patient health-care services performed for said patients by health-care providers with said group of health-care providers; (B) a second database for storing out-patient data records representative of out-patient health-care services performed for said patients by health-care providers with said group of health-care providers; (C) an episode builder, coupled to said first and second databases, for building a plurality of sickness episode data records by combining information from said in-patient and out-patient data records, each sickness episode data record within said plurality of sickness episode data records corresponding to an individual sickness episode for which health-care services were performed for one of said patients by at least one health-care provider from said group of health-care providers; (D) a severity assessment means, coupled to said episode builder, for performing an objective severity assessment on a group of sickness episode data records and assigning, in response to said objective severity assessment, an episode severity score to each sickness episode data record within said group of sickness episode data records; and (E) case load assessment means, coupled to said severity assessment means, for objectively determining case load complexity levels for health-care providers within said group of health-care providers from said severity scores.
Claim 13
Dependent Claim
38 words
The apparatus of claim 10, wherein said individual sickness episode corresponds to a time period that begins when a patient is injured or begins to feel sick and ends when said patient is no longer injured or sick.
Claim 14
Dependent Claim
32 words
The apparatus of claim 11, wherein said time period begins before any health-care services were performed for said patient by said at least one healthcare provider from said group of health-care providers.
Claim 15
Dependent Claim
34 words
The apparatus of claim 10, wherein said patient case load complexity levels determined by said case load assessment means are representative of patients that received a common procedure from one of said health-care providers.
Claim 16
Dependent Claim
57 words
The apparatus of claim 13, wherein a plurality of case load complexity levels are determined by said case load assessment means for each health-care provider within said group of health-care providers, each of said plurality of case load complexity levels corresponding to a different common procedure performed for said patients by said group of health care providers.
Claim 17
Dependent Claim
21 words
The apparatus of claim 14, further comprising: (F) benchmark determining means for determining a severity comparison benchmark for said common procedure.
Claim 18
Dependent Claim
54 words
The apparatus of claim 15, wherein said benchmark determining means includes means for determining a plurality of severity comparison benchmarks for said common procedure including first and second severity comparison benchmarks for said common procedure, said first severity comparison benchmark corresponding to a more complex case load level than said second severity comparison benchmark.
Claim 19
Dependent Claim
49 words
The apparatus of claim 15, wherein said benchmark determining means includes means for selecting from said case load complexity levels determined by said case load assessment means a plurality of case load complexity levels falling within a predetermined range and averaging said plurality of selected case load complexity levels.
Claim 20
Dependent Claim
53 words
The apparatus of claim 15, wherein said benchmark determining means includes means for selecting from said case load complexity levels determined by said case load assessment means a plurality of case load complexity levels falling within a predetermined range and determining a statistical median of said plurality of selected case load complexity levels.
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USPTO Annuity & Maintenance Windows
| Annuity Stage | Window Opens | Payment Deadline | Surcharge Period Until | Estimated Fee | Status |
|---|---|---|---|---|---|
| 3.5 Years (Year 4) | 2001-01-05 | 2001-07-07 | 2002-01-06 | $2000.00 | Window Closed / Lapsed |
| 7.5 Years (Year 8) | 2005-01-05 | 2005-07-07 | 2006-01-06 | $3760.00 | Window Closed / Lapsed |
| 11.5 Years (Year 12) | 2009-01-05 | 2009-07-07 | 2010-01-06 | $7700.00 | Window Closed / Lapsed |