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1. 发明授权

US5970463A Medical claims integration and data analysis system 失效
标题翻译：医疗索赔整合与数据分析系统
公开(公告)号：US5970463A
公开(公告)日：1999-10-19
申请号：US641556
申请日：1996-05-01
申请人： Douglas G. Cave , Bradley Munson
发明人： Douglas G. Cave , Bradley Munson
IPC分类号： G06F19/00 , G06F159/00
CPC分类号： G06F19/328 , G06F19/322 , G06F19/323 , G06F19/3487 , G06Q50/22 , G06Q50/24
摘要： A medical claims analysis system and method categorizes medical claims into episodes of care having predetermined diagnostic cluster types. The system analyzes medical claim items, some of which have principal diagnosis codes, and some of which have non-principal, missing, or incorrect diagnosis codes. Patient treatment episodes (PTEs) are formed from the principal diagnosis codes, each PTE being of a particular diagnostic cluster type. The system categorizes non-principal-diagnosis claim items into the PTEs on the basis of temporal, physiological or clinical relationships between the claim items and the PTEs. A drug lookup table enables drug claims to be properly categorized in the PTEs. A diagnostic cluster lookup table enables claim items to be categorized into PTEs with ongoing treatment windows for which the diagnosis code of the claim item is in the diagnostic cluster lookup table. The system merges PTEs of the same diagnostic cluster type when the treatment windows of the PTEs overlap. The system attempts to recategorize medical claims into merged PTEs. The system analyzes each PTE to determine the presence of required diagnoses and eliminates any PTE without a required diagnosis. The system also identifies and merges PTEs that are clinically related or clinically similar. In a system for integrating medical claims data, medical claim items that are in different data formats and/or use different coding systems are analyzed, and related claim items are categorized in a common coding system.
摘要翻译：医疗索赔分析系统和方法将医疗索赔分类为具有预定诊断簇类型的护理情节。系统分析医疗索赔项目，其中一些具有主要诊断代码，其中一些具有非校准，缺失或错误的诊断代码。患者治疗事件（PTE）由主要诊断代码形成，每个PTE是特定的诊断集群类型。该系统根据索赔项目和PTE之间的时间，生理或临床关系将非主要诊断索赔项目分类为PTE。药物查询表使毒品索赔能够在PTE中得到适当的分类。诊断集群查找表使得索赔项目可以被分类为具有正在进行的治疗窗口的PTE，其中权利要求项目的诊断代码在诊断集群查找表中。当PTE的处理窗口重叠时，系统会合并相同诊断集群类型的PTE。该系统尝试将医疗索赔重新归类为合并的PTE。系统分析每个PTE以确定是否存在所需的诊断，并且在没有所需诊断的情况下消除任何PTE。该系统还识别和合并临床相关或临床相似的PTE。在用于集成医疗索赔数据的系统中，分析处于不同数据格式和/或使用不同编码系统的医疗索赔项目，并且相关的权利要求项目被分类在公共编码系统中。

2. 发明授权

US08751263B1 Method and system for producing statistical analysis of medical care information 有权
标题翻译：医疗信息统计分析方法与系统
公开(公告)号：US08751263B1
公开(公告)日：2014-06-10
申请号：US13621222
申请日：2012-09-15
申请人： Douglas G Cave , Yuri Alexandrian , John T Calvin , Jenine A Lara
发明人： Douglas G Cave , Yuri Alexandrian , John T Calvin , Jenine A Lara
IPC分类号： G06Q50/00
CPC分类号： G06Q50/22 , G06F19/00 , G06Q10/10
摘要： A method and system for producing statistical analysis of medical care information comprises: aggregating medical care providers; computing a statistical analysis, such as performing Pearson's correlation analysis. that includes associating a metric for each set of codes obtained from the aggregated medical care information; associating an efficiency metric from the medical care efficiency measurements for each medical care provider with that medical care provider; calculating a correlation value for each medical care provider between their efficiency metric and a metric associated with each code; and selecting a subset of codes based on the correlation values.
摘要翻译：医疗信息统计分析方法和系统包括：汇总医疗保健提供者; 计算统计分析，如执行Pearson相关分析。其包括将从所述汇总医疗保健信息获得的每组代码相关联的度量; 将每个医疗保健提供者的医疗效率测量的效率度量与该医疗保健提供者相关联; 计算每个医疗保健提供者在其效率度量和与每个代码相关联的度量之间的相关值; 以及基于相关值选择代码子集。

3. 发明授权

US08639528B1 Efficiency measurement and patient health risk stratification utilizing variable windows for episode creation 有权
标题翻译：效率测量和患者健康风险分层利用可变窗口创作
公开(公告)号：US08639528B1
公开(公告)日：2014-01-28
申请号：US13621234
申请日：2012-09-15
申请人： Douglas G. Cave
发明人： Douglas G. Cave
IPC分类号： G06Q10/00 , G06Q50/00 , A61B5/00 , G06F19/00
CPC分类号： G16H40/20 , A61B2505/05 , G06F19/00 , G06Q10/10 , G06Q30/02 , G06Q50/22
摘要： A method for measuring physician efficiency and patient health risk stratification is disclosed. Episodes of care are formed from medical claims data and an output process is performed. Physicians are assigned to report groups, and eligible physicians and episode assignments are determined. Condition-specific episode statistics and weighted episode statistics are calculated, from which physician efficiency scores are determined.
摘要翻译：公开了一种用于测量医师效率和患者健康风险分层的方法。护理情节由医疗索赔数据形成，执行输出处理。医师被分配到报告组，合格的医师和事件分配确定。计算病情特定情节统计和加权发作统计，从中确定医师效率得分。

4. 发明授权

US08301464B1 Method and system for producing statistical analysis of medical care information 有权
标题翻译：医疗信息统计分析方法与系统
公开(公告)号：US08301464B1
公开(公告)日：2012-10-30
申请号：US12473147
申请日：2009-05-27
申请人： Douglas G. Cave , Yuri Alexandrian , John T. Calvin , Jenine A. Lara
发明人： Douglas G. Cave , Yuri Alexandrian , John T. Calvin , Jenine A. Lara
IPC分类号： G06Q50/00
CPC分类号： G06Q50/22 , G06F19/00 , G06Q10/10
摘要： A method and system for producing statistical analysis of medical care information comprises: aggregating medical care providers to a peer group level; aggregating medical care information at the peer group level and at the medical care provider level; computing a statistical analysis, such as performing Pearson's correlation analysis; and generating peer group level and medical care provider level results utilizing the computed statistical analysis. Also, a method for producing statistical analysis of medical care information for a medical care provider efficiency measurement comprises: applying minimum unit of analysis criteria for medical care providers to be used in statistical analysis; calculating an overall weighted average medical care information measure for each medical care provider; calculating a medical condition-specific medical care information measure for each medical care provider; removing outlier medical care providers from statistical analysis at medical care information level; calculating a statistical analysis to medical care provider efficiency measurement at each medical care information level using a statistical calculation; and selecting statistically related medical care information to identify medical care providers meeting a desired practice pattern.
摘要翻译：一种用于生成医疗信息统计分析的方法和系统包括：将医疗保健提供者聚集到对等组; 在同行群体层面和医疗保健提供者层面汇总医疗信息; 计算统计分析，如执行Pearson相关分析; 并使用计算的统计分析产生同伴组级别和医疗保健提供者级别结果。另外，用于生成用于医疗服务提供者效率测量的医疗保健信息的统计分析的方法包括：应用用于统计分析的医疗保健提供者的最小单位分析标准; 计算每个医疗保健提供者的总体加权平均医疗信息度量; 计算每个医疗保健提供者的医疗状况特定医疗信息度量; 从医疗信息层面的统计分析中消除异地医疗服务提供者; 使用统计计算计算每个医疗信息水平的医疗保健提供者效率测量的统计分析; 以及选择统计学上相关的医疗信息来识别满足期望的实践模式的医疗保健提供者。

5. 发明授权

US08340981B1 Method, system, and computer program product for physician efficiency measurement and patient health risk stratification utilizing variable windows for episode creation 有权
标题翻译：方法，系统和计算机程序产品，用于医生效率测量和患者健康风险分层，利用可变窗口进行创作
公开(公告)号：US08340981B1
公开(公告)日：2012-12-25
申请号：US13012219
申请日：2011-01-24
申请人： Douglas G. Cave
发明人： Douglas G. Cave
IPC分类号： G06Q10/00 , G06Q50/00 , A61B5/00 , G06F19/00
CPC分类号： G16H40/20 , A61B2505/05 , G06F19/00 , G06Q10/10 , G06Q30/02 , G06Q50/22
摘要： A method for measuring physician efficiency and patient health risk stratification is disclosed. Episodes of care are formed from medical claims data and an output process is performed. Physicians are assigned to report groups, and eligible physicians and episode assignments are determined. Condition-specific episode statistics and weighted episode statistics are calculated, from which physician efficiency scores are determined.
摘要翻译：公开了一种用于测量医师效率和患者健康风险分层的方法。护理情节由医疗索赔数据形成，执行输出处理。医师被分配到报告组，合格的医师和事件分配确定。计算病情特定情节统计和加权发作统计，从中确定医师效率得分。

6. 发明授权

US07739126B1 Method, system, and computer program product for physician efficiency measurement and patient health risk stratification 有权
标题翻译：方法，系统和计算机程序产品，用于医师效能测量和患者健康风险分层
公开(公告)号：US07739126B1
公开(公告)日：2010-06-15
申请号：US10794216
申请日：2004-03-05
申请人： Douglas G. Cave , Kyu Sung Cho
发明人： Douglas G. Cave , Kyu Sung Cho
IPC分类号： G06Q10/00 , G06Q50/00 , A61B5/00 , G06F19/00
CPC分类号： G06Q50/24 , G06F19/00 , G06Q50/22 , G16H40/20
摘要： A method for measuring physician efficiency and patient health risk stratification is disclosed. Episodes of care are formed from medical claims data and an output process is performed. Physicians are assigned to report groups, and eligible physicians and episode assignments are determined. Condition-specific episode statistics and weighted episode statistics are calculated, from which physician efficiency scores are determined.
摘要翻译：公开了一种用于测量医师效率和患者健康风险分层的方法。护理情节由医疗索赔数据形成，执行输出处理。医师被分配到报告组，合格的医师和事件分配确定。计算病情特定情节统计和加权发作统计，从中确定医师效率得分。

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