Data processing: financial – business practice – management – or co – Automated electrical financial or business practice or... – Health care management
Reexamination Certificate
1999-09-15
2002-11-19
Trammell, James P. (Department: 3621)
Data processing: financial, business practice, management, or co
Automated electrical financial or business practice or...
Health care management
Reexamination Certificate
active
06484144
ABSTRACT:
FIELD OF THE INVENTION
The present invention relates generally to data processing systems and, more specifically, to an assessment and planning system that uses a multi-factorial computation of risk to determine an appropriate strategy for preventing an entity from entering an undesirable state.
BACKGROUND OF THE INVENTION
A patient generally seeks medical advice and treatment from a healthcare provider when the patient experiences a medical condition that the patient is unable to treat. The term healthcare as used herein refers generally to any activity directed to the care and maintenance of a patient (e.g., a human being). A healthcare provider may thus provide services directed to the mental, emotional, or physical well-being of a patient. Accordingly, healthcare providers may include, for example, psychiatrists, podiatrists, dentists, substance abuse counselors, etc. A healthcare provider diagnoses a condition, or disease, and recommends a course of treatment to cure the condition, if such treatment exists. This model of reparative healthcare treatment focuses only on healing, or repairing, an existing condition.
To determine an appropriate treatment for an existing condition, a healthcare provider runs a series of diagnostic tests and collects clinical data related to the patient's symptoms. The term “clinical data” refers to the data measured and observed by a healthcare provider during examination of a patient, reflecting the patient's health, or related to a health condition. The clinical data generally reflects the effects of a disease as determined at a point in time. For example, if a patient has a tumor, a healthcare provider may collect clinical data reflecting the tumor's size, appearance, location, and texture.
After collecting the clinical data, the healthcare provider forms hypotheses about the cause of the condition, its severity, and its impact. Next, the healthcare provider diagnoses the condition and determines how to treat the condition. The patient only provides input into this process by enumerating symptoms and giving background information about the condition or related conditions.
Alternatively, a patient or healthcare provider may input clinical data into a computer program that calculates a value of risk. The risk value output by the computer program is a quantified measure indicating a patient's likelihood of currently having a condition or disease as indicated by the patent's symptoms. This computed value of risk may be considered in diagnosing a condition or disease.
For example, consider a situation where a patient enters a dentist's office with red, swollen gums, extreme sensitivity to both hot and cold substances, and pain in several areas of her mouth. The dentist hypothesizes that the patient has periodontal disease. Or alternatively, the dentist inputs an enumerated list of the patient's symptoms into a computer program which outputs a quantified indicator of the patient's likelihood of either having periodontal disease, or if the patient's periodontal disease is in remission, having an exacerbation of the periodontal disease.
Before proceeding with a diagnosis and plan for treatment, suppose the dentist runs a series of tests and makes observations to determine the accuracy of the initial hypothesis or indicator value. During the examination, suppose the dentist finds significant bone loss associated with several teeth and decides to restore the areas of bone loss with a bone graft procedure. After performing the bone graft procedure, the dentist submits claim forms to the patient's insurance carrier for approval. The dentist may further recommend that the patient initiate a scheme of improved oral hygiene, including regular professional cleaning appointments to minimize or retard the effects of periodontal disease. Absent any obviously related complications, the patient and dentist consider the treatment a success and continue their relationship. If the insurance company refuses payment the patient must absorb the cost of the procedure.
This reparative model for healthcare treatment fails to consider how a patient's intended behavior impacts the effectiveness of the treatment. In the example above, the patient's condition may have been exacerbated by the patient's smoking habit that the patient has no intention of ceasing. Additionally, the patient may be unable or unwilling to improve her oral hygiene. Both of these factors contribute to the effectiveness and longevity of a bone graft procedure. The model also fails to direct treatment towards the prevention of future conditions. For instance, in the example above, the patient's periodontal disease is likely to worsen over time, absent any changes in the patient's oral care. The bone graft procedure used to treat the most severe areas of bone loss fails to retard, prevent, or otherwise impact other areas of the patient's gums that have been effected by the periodontal disease. Therefore, performing a bone graft, an intrusive and unpredictable procedure, as the only form of treatment, may not be the best treatment because it fails to address the likely progression of the disease and a potential need for subsequent treatment related to a current condition. A reparative treatment planning scheme fails to consider that current symptoms reflect only one indicator of the significance or severity of a condition. Further, the reparative model for treatment fails to consider the patient's medical history and its impact on the effectiveness and longevity of treatment.
Overall, the reparative model for healthcare treatment planning focuses solely on healing an existing condition as indicated by diagnostic tests and clinical data. This model fails to consider various other factors that impact the effectiveness of treatment. As a result, the most effective and comprehensive treatment may not be administered. Similarly, because the reparative model fails to focus on preventing future conditions, it is likely to result in a higher number of procedures needed on a long-term basis. Patients and insurance companies experience inflated economic healthcare costs when healthcare providers administer unnecessary, overly intrusive, or ineffective treatment, or treatment that contributes to a new disease. Additionally, patients absorb high non-economic costs, in the form of emotional, mental, or physical anxiety, when they are subjected to unnecessary or overly intrusive procedures, as determined in light of the patient's overall state of health. It is therefore desirable to improve healthcare systems.
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Derwent-Acc-No: 1998-077332;Bortolotti, M. J. et al.; Dec. 1997.*
Group Practice Managed Healthcare, V11 n7 pl (2) Jul. 1995; Dial William F.*
James D. Beck, “Method of Assessing Risk for Periodontitis and Developing Multifactorial Models,” May 1994 (Supplement), Risk Assessment and Multifactorial Models, J Periodontol vol. 65 No. 5, pp. 468-478.
Maurizio S. Tonetti, “Cigarette Smoking and Periodontal Diseases: Etiology and Management of Disease,” Annals of Periodontology, Jul. 1998, vol. 3, No. 1, pp.88-101.
Martin John
Nolf Randy
Dental Medicine International L.L.C.
Elisca Pierre E
Fish & Richardson P.C.
Trammell James P.
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