00-022: Episodes of Care Classification & Severity Assessment System

The quantitative construction and assessment of "episodes of care" incorporating severity analysis constitutes a break-through in relation-based episode classification systems.

Easily implemented as a feature set of any existing medical records data management system, this systematic approach imparts significant enhancement to existing episode classification systems and provides the user with a clear understanding of the data source and manipulation techniques. Unique to this classification system are the elimination of pre-defined diagnostic clusters and the incorporation of a severity episode analyzer. These added features allow for the inclusion of important clinical nuances and intensity-based measures even when mining and manipulating vast amounts of data. Based on a discrete algorithm this iterative process analyses patient, diagnostic, time of diagnosis, and extrapolated severity scores to establish anchor diagnosis and subsequent episodes of care.
- Discrete analysis and correlation of episode severity
- Eliminates classifying diagnoses into clusters of diseases
- Provides for outcome and efficiency analysis of episode of care
- Easily integrated into any administrative database
- Construct episodes of care for specific diseases

Market Significance:
Identifying episodes of care and providing meaningful data analysis is fundamental in determining both cost and quality of healthcare. Although numerous analytical approaches exist today most do not describe the methodologies used due to their proprietary nature. Those that are published appear to rely on heuristics with no basis in mathematical theory. The proposed mathematical model eliminates the "black box" associated with episode of care construction and evaluation. Improved diagnostic analysis of patient health histories yields better-quality data sets for use in any health management tool that is dependent upon evaluation of episodes of care. Currently episodes of care are integral to assessing capitation rates: ambulatory diagnoses, care, and visit grouping; disease staging; health risk assessment and adjustments; and clinician performance. This assessment tool can be easily incorporated as a feature set of any electronic record keeping system. Potential rewards:
- Maximizes reimbursements
- Improves accuracy of diagnostic records
- Quantify clinician and doctor performance
- Quality of care quantified