Method and system for measuring management effectiveness

Abstract

A system and process are presented in which the factors of quality, cost, and access are integrated in such a manner as to provide a holistic description of the effectiveness of care at medical treatment facilities (MTFs). By using medical treatment data from a variety of computerized databases and incorporating patient perceptions of care through the use of surveys, the effectiveness of a particular facility's medical care can be compared to other medical care facilities. Deficiencies in performance are readily identified through this process, permitting goals and targets to be established that provide direction for medical administrators to enhance medical care at their treatment facilities. This approach is applicable to any set of medical care facilities, and also to just about any organized human endeavor involving quality, cost and access factors.

Claims

What is claimed is:

1. A process for evaluating effectiveness of service among a set of treatment facilities, said process comprising the steps of:

gathering data quantifying quality, cost, and access performance characteristics of each of the treatment facilities;

displaying the quality, cost and access performance characteristics simultaneously on a graph to indicate thereby strong and weak quality, cost and access performance characteristics; and

identifying the strong and weak quality, cost and access performance characteristics of each treatment facility.

2. A process, as defined in claim 1, wherein said displaying step is performed using a three-dimensional cube using a separate axis for the quality, cost and access performance characteristics.

3. A process, as defined in claim 2, wherein said displaying step is performed on said graph by charting the quality performance characteristics such that: ##EQU4## where: i is a quality indicator;

.beta.is an adjustment factor based on an average severity indexing for a particular treatment facility;

I is a quality indicator value at a particular treatment facility;

.mu. is a mean value of the QIP indicator for all treatment facilities;

.sigma. is a standard deviation for a QIP indicator based on all treatment facilities; and

.epsilon. is a patient perception adjustment factor (-0.1,0,0.1).

4. A process, as defined in claim 3, wherein said displaying step is performed on said graph by charting the access performance characteristics such that: ##EQU5## where i indicates inhouse client;

C is a preselected average daily client load;

D is particular hospital average daily client;

G is the goal for appointments;

R is the number of available appointments; and

.epsilon. is an adjustment for client perception of access (-0.1,0,0.1).

5. A process, as defined in claim 4 wherein said displaying step is performed on said graph by charting the cost performance characteristics such that are given by: ##EQU6## where: i is an inhouse client indicator;

.beta. is an adjustment factor for case weight, severity, and a ratio of direct cost to total cost;

I direct cost per catchment area employee; and

.mu. is a benchmark cost against which facility costs are compared.

6. A process, as defined in claim 3 wherein said displaying step is performed on said graph by charting the cost performance characteristics such that are given by: ##EQU7## where: i is an inhouse client indicator;

.beta. is an adjustment factor for case weight, severity, and a ratio of direct cost to total cost;

I direct cost per catchment area employee; and

.mu. is a benchmark cost against which facility costs are compared.

7. A process, as defined in claim 2, wherein said displaying step is performed on said graph by charting the access performance characteristics such that: ##EQU8## where i indicates inhouse client;

C is a preselected daily client load;

D is a particular hospital average daily client;

G is the goal for appointments;

R is the number of available appointments; and

.epsilon. is an adjustment for client perception of access (-0.1,0,0.1).

8. A process, as defined in claim 7 wherein said displaying step is performed on said graph by charting the cost performance characteristics such that are given by: ##EQU9## where: i is an inhouse client indicator;

.beta. is an adjustment factor for case weight, severity, and a ratio of direct cost to total cost;

I direct cost per catchment area employee; and

.mu. is a benchmark cost against which facility costs are compared.

9. A process, as defined in claim 2 wherein said displaying step is performed on said graph by charting the cost performance characteristics such that are given by: ##EQU10## where: i is an inhouse client indicator;

.beta. is an adjustment factor for case weight, severity, and a ratio of direct cost to total cost;

I direct cost per catchment area employee; and

.mu. is a benchmark cost against which facility costs are compared.

10. A process, as defined in claim 1, wherein said displaying step is performed on said graph by charting the quality performance characteristics such that: ##EQU11## where: i is a quality indicator;

.beta.is an adjustment factor based on an average severity indexing for a particular treatment facility;

I is a quality indicator value at a particular treatment facility;

.mu. is a mean value of the QIP indicator for all treatment facilities;

.sigma. is a standard deviation for a QIP indicator based on all treatment facilities; and

.epsilon. is a patient perception adjustment factor (-0.1,0,0.1).

11. A process, as defined in claim 10, wherein said displaying step is performed on said graph by charting the access performance characteristics such that: ##EQU12## where i indicates inhouse client;

C is a preselected average daily client load;

D is a particular hospital average daily client;

G is the goal for appointments;

R is the number of available appointments; and

.epsilon. is an adjustment for client perception of access (-0.1,0, 0.1).

12. A process, as defined in claim 11 wherein said displaying step is performed on said graph by charting the cost performance characteristics such that are given by: ##EQU13## where: i is an inhouse client indicator;

.beta. is an adjustment factor for case weight, severity, and a ratio of direct cost to total cost;

I direct cost per catchment area employee; and

.mu. is a benchmark cost against which facility costs are compared.

13. A process, as defined in claim 10 wherein said displaying step is performed on said graph by charting the cost performance characteristics such that are given by: ##EQU14## where: i is an inhouse client indicator;

.beta. is an adjustment factor for case weight, severity, and a ratio of direct cost to total cost;

I direct cost per catchment area employee; and

.mu. is a benchmark cost against which facility costs are compared.

14. A process, as defined in claim 1, wherein said displaying step is performed on said graph by charting the access performance characteristics such that: ##EQU15## where i indicates inhouse client;

C is one facility average daily client load;

D is another facility daily client load;

G is the goal for appointments;

R is the number of available appointments; and

.epsilon. is an adjustment for client perception of access (-0.1,0,0.1).

15. A process, as defined in claim 14 wherein said displaying step is performed on said graph by charting the cost performance characteristics such that are given by: ##EQU16## where: i is an inhouse client indicator;

.beta. is an adjustment factor for case weight, severity, and a ratio of direct cost to total cost;

I direct cost per catchment area employee; and

.mu. is a benchmark cost against which facility costs are compared.

16. A process, as defined in claim 1 wherein said displaying step is performed on said graph by charting the cost performance characteristics such that are given by: ##EQU17## where: i is an inhouse client indicator;

.beta. is an adjustment factor for case weight, severity, and a ratio of direct cost to total cost;

I direct cost per catchment area employee; and

.mu. is a benchmark cost against which facility costs are compared.

17. A system for evaluating effectiveness of service among a set of treatment facilities, said system comprising:

a means for gathering data quantifying quality, cost, and access performances characteristics of each of the treatment facilities;

a means for displaying the quality, cost and access performance characteristics simultaneously on a graph to indicate thereby strong and weak quality, cost and access performance characteristics; and

a means for identifying the strong and weak quality, cost and access performance characteristics of each treatment facility.

18. A system, as defined in claim 17, wherein said displaying means comprises a computer monitor which is connected to a computer which is programmed to depict the quality, cost and access performance characteristics in a chart that simulates a three-dimensional cube which has a separate axis for the quality, cost, and access performance characteristics.

Description

BACKGROUND OF THE INVENTION

This invention relates generally to a method and system for utilizing management effectiveness, and more specifically to a method and system for providing medical care at a reasonable cost for all the nation's citizens. Existing tools, which focus on single measurement parameters in isolation, do not convincingly capture the way health care facilities operate. At least in part for this reason, such tools have failed to inspire significant practice pattern changes and/or management efficiencies, even in light of the current furor over U.S. health care spending. Therefore, we designed and developed a method and system of integrated medical organizational performance across the parameters of quality, cost, and access. Without a complete understanding by medical managers of these underlying issues of medical care, solutions to the medical problems of this country are not achievable. Large scale improvements in the current state of medical care require a standard which compels management's attention to the proper balance between these competing but interrelated forces.

The task of evaluating the factors of quality, cost, and access in such a manner as to provide a holistic description of the effectiveness of medical treatment data, is alleviated, to some extent, by the systems disclosed in the following U.S. Patents, the disclosures of which are incorporated herein by reference:

U.S. Pat. No. 5,128,860 issued to Chapman

U.S. Pat. No. 5,117,353 issued to Stipanovich et al.

U.S. Pat. No. 4,992,939 issued to Tyler

U.S. Pat. No. 4,975,840 issued to Detore et al.

U.S. Pat. No. 4,893,270 issued to Beck et al.

U.S. Pat. No. 4,858,121 issued to Barber et al.; and

U.S. Pat. No. 4,667,292 issued to Mohlenbrock et al.

The patent to Mohlenbrock et al. discloses patient billing for hospital care. The computer billing is reviewed by the physician each day. The patent to Beck et al. discloses a medical information updating system for patents. The patent to Tyler discloses a method of producing a narrative report. The Tyler system analyzes information which has been inputted to a database and using predetermined phrases intermingled with extracts from the database, produce a narrative analytical report which describes the critical aspects of the database. The Tyler system also produces a listing of questions on those aspects of the database which require explanation of clarification. The patents to Barber et al., Detore et al., Stipanovich et al., and Chapman are of interest, but they do not model medical care facilities (MTFs) based on quality of care, cost, and access.

Currently, medical care is not evaluated in a holistic manner. Instead, quality is examined in isolation from cost and neither of these is compared to access which is rarely, if ever, evaluated. In addition, there is a lack of commonality between the evaluation criteria that do exist, making comparisons between treatment facilities and medical practitioners infeasible. As a result, goals for improvements in medical care cannot be established except in individual hospitals.

In terms of cost, there are many criteria that are used, whether for the cost of supplies or provider charge rates. Since none of these cost criteria are universal, it is difficult to compare different hospitals on the basis of cost. Also, accounting practices differ causing further complications. To make medical care affordable for all people in this country, it is imperative that definitions of cost be standardized.

Quality of medical care is almost universally defined in terms of mortality rates, which has not proven to be very useful. At least one study has indicated that even the best hospitals can now and then have unfavorable mortality rates. When using mortality figures to evaluate quality of care, it is important to separate those that were expected to die from those that were not. This is not currently done and is not easy to do, especially in terms of the litigation such a practice would cause in insurance and medical industries (i.e. lawsuits over those persons that should not have died). As a result, mortality in and of itself does not describe "quality" medical care and is not a useful metric to use to try to solve the medical problems facing this country.

Access to medical care is not directly measurable. Since there are many hospitals and medical practitioners from which to choose, at least in urban areas, it would be infeasible to attempt to associate the number of people that should have access to a particular hospital or doctor. The only "measurable" criteria for access to medical care are media accounts and government estimates of people who have little or no medical insurance and thereby are assumed to have a lack of access to medical care. Again, definitions are important since medical care is available, its just that people cannot afford it.

To assess how well a hospital or doctor provides medical care, and to establish the cost effectiveness of that care, the three factors of quality, cost, and access must be evaluated simultaneously. Current methods of measuring these factors are lacking and provide little useful information to the medical manager. Without an overall perspective of how these factors interrelate and how an improvement in one can lead to a change in another, medical managers cannot be expected to achieve improvements that would lead to a cost effective medical care program for everyone in the country.

SUMMARY OF THE INVENTION

The invention is a process and system of modeling the factors of quality, cost, and access in such a manner as to provide a holistic description of the effectiveness of medical treatment data from a variety of computerized databases and incorporating patient perceptions of medical care through the use of surveys. This allows effectiveness of different groups of medical care facilities to be compared to each other. Deficiencies in performance are readily identified through this process, permitting goals and targets to be established that provide direction for medical administrators to enhance medical care at their treatment facilities.

One embodiment of the invention may be considered a process for evaluating effectiveness of service among a set of treatment facilities, the process includes the steps of: gathering data quantifying quality, cost, and access performances characteristics of each of the treatment facilities; displaying the quality, cost and access performance characteristic simultaneously on a graph to indicate thereby strong and weak quality, cost and access performance characteristics; and identifying the strong and weak quality, cost and access performance characteristics of each treatment facility.

To ensure that all medical treatment facilities are considered fairly, adjustments are made to the data based on patient severity of illness, the amount of resources used for treatment (case weight), and the ratio of direct military care costs to CHAMPUS costs. These adjustments are applied to equations that have been developed for each of the three factors (quality, cost, and access), providing a quantitative three dimensional cube permitting managers to assess the overall effectiveness of their treatment facilities. For simplicity, each factor is divided into "High" and "Low" regions.

Another embodiment of the invention is a system for evaluating effectiveness of service among a set of treatment facilities. This system uses commercially-available computers as a means for gathering data quantifying quality, cost, and access performances characteristics of each of the treatment facilities. This system uses a central computer as a means for identifying the strong and weak quality, cost and access performance characteristics of each treatment facility. The central computer is also an ordinary computer with a computer monitor that serves as a means for displaying the quality, cost and access performance characteristics simultaneously on a graph to indicate thereby strong and weak quality, cost and access performance characteristics. The central computer is programmed to depict the quality, cost and access performance characteristics in a chart that simulates a three-dimensional cube which has a separate axis for the quality, cost, and access performance characteristics.

The object of the invention is to provide a system and process that evaluates the quality cost and access of treatment facilities, and identify deficiencies thereby.

This object together with other objects, features and advantages of the invention will become more readily apparent from the following detailed description when taken in conjunction with the accompanying drawings wherein like elements are given like reference numerals throughout.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is an illustration of a cube used in the invention to depict quality, cost and access graphically;

FIGS. 2A and B are charts depicting how the QIP indicator is adjusted for patient perception (FIG. 2A) and for the severity index effect (FIG. 2B);

FIGS. 3A, 3B and 3C are charts of adjustments to cost;

FIGS. 4 and 5 respectively illustrates the use of the cube of FIG. 1 to chart top and bottom performing treatment facilities; and

FIG. 6 is a distributed computer data system.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The present invention can be regarded as a process and system for identifying possible deficiencies among a set of treatment facilities. The process includes the steps of: measuring actual quality, cost and access performance characteristics of the treatment facilities; establishing standards of performance values for quality, cost and access for the treatment facilities; and comparing the actual quality, cost and access performance characteristics of each of the treatment facilities with the standards of performance values of quality, cost and access to identify thereby the possible deficiencies in the treatment facilities.

In this process, each of the treatment facilities is a medical treatment facility, and the measuring step for quality is performed using a Quality Indicator Project service which provides the measure of quality performance characteristics for each medical treatment facility. Also in this process, the measure of quality and cost performance characteristics are adjusted for both patient perception of treatment and for severity of illness to produce thereby the actual quality performance characteristics of each medical treatment facility. Finally note that the establishing step is performed by producing the standards of performance values by averaging the quality, cost and access performance characteristics to produce a set of average values, and wherein the company step is performed by counting magnitudes of deviation between the actual quality, cost and access performance characteristics and their respective averages among the set of average values.

As discussed below, the present invention can also be considered a system which performs the steps recited above using a distributed computer network.

The interrelated factors of quality, cost, and access suggested a three dimensional relationship, for example a response surface, since each measure is conceivably continuous. For simplicity, however, criteria were established so as to access each factor as being favorable or unfavorable. As such, a cube of eight octants is used to simultaneously depict graphically the factors of quality, cost, and access as shown by FIG. 1. For example, a treatment facility that was the most effective would meet or exceed established criteria for each of these measures (i.e. high quality, low cost, high access). Treatment facilities that are deficient in meeting the established performance goal in one or more measures would indicate that some level of improvement is warranted. Visually, by color coding the octants of the cube (all favorable="green", one unfavorable="yellow", two or more unfavorable="red"), the overall performance of the treatment facility would be readily apparent, making the representation a useful management tool.

It is important to note, however, that placement in the cube does not necessarily indicate good effectiveness. For example, a treatment facility that did not meet the criterion established for "quality" does not mean that the facility exhibited poor quality, per se. This is only an indication that performance appears to be below established values. The reasons for this less than desired performance could then be explored, and possibly explained satisfactorily by circumstances not encompassed by the model.

As lower rated treatment facilities improve in quality, the criterion would be adjusted upward so that it continues to allow discrimination between higher and lower levels of performance. The treatment facilities, therefore, should not only attempt to meet established criteria, but should seek continued improvement since the criteria will eventually reflect higher overall expected levels of performance.

Conceptually, the positioning of a treatment facility in the cube is indicative only of relative rating. However, by using data gathered from several sources, a more complete picture of facility performance can be shown. Of the three measures of performance, cost and access can be measured objectively. A quality measure, however, is much more subjective. Nevertheless, objective data are available that can be useful in this regard.

Quality is both an actual fact and a perception on the part of the patient. If a patient actually receives quality care but perceives it otherwise, the patient is apt not to elect future treatment from the facility or the provider, adversely affecting the access measure. Nevertheless, the emphasis should remain with actual quality of care as evidenced by data from the treatment facility, perhaps with some adjustment for patient perceptions. The method used here for examining quality of care is the Maryland Quality Indicator Project (QIP), to which a number of civilian and Department of Defense (DOD) hospitals are subscribers. Using data from hospitals nationwide, ten indicators have been selected as measures of quality. However, these indicators do not account for severity of illness or resource usage (case mix), which must be considered when performing comparisons between treatment facilities.

Equation 1, as presented below, denotes the process by which quality is calculated. Note that it is a summation over all ten QIP quality measures, adjusted first for severity of illness and then measured in terms of magnitude of deviation from an average value. This permits different treatment facilities to be compared on an equal basis. ##EQU1## where

i is the QIP indicator

.beta. is an adjustment factor based on an average severity indexing for a particular treatment facility

I is the QIP indicator value at a particular treatment facility

.mu. is the mean value of the QIP indicator for all treatment facilities

.sigma. is the standard deviation of a QIP indicator based on all treatment facilities

.epsilon. is a patient perception adjustment factor (-0.1,0,0.1)

As mentioned above, the method used here for examining quality of care uses the Maryland Quality Indicator Project (QIP), to which a number of civilian and Department of Defense (DOD) hospitals are subscribers. Using data from hospitals nationwide, ten indicators have been selected as measures of quality. These indicators are shown in Table 1 but they do not account for severity of illness or resource usage (case mix), which must be considered when performing comparisons between treatment facilities.

                  TABLE 1
    ______________________________________
    QUALITY INDICATORS
    ______________________________________
    I    Hospital Acquired Infections
    II   Surgical Wound Infections
    III  Inpatient Mortality
    IV   Neonatal Mortality (1801 grams only)
    V    Perioperative Mortality
    VI   Cesarean Sections
    VII  Unplanned Admissions Following Ambulatory Procedure
    IX   Unplanned Returns to Special Care Unit
    X    Unplanned Returns to Operating Room.
    ______________________________________

• Inventors
  Torma, Michael J.; Galing, Bernard W.; Palmer, Robert J.; West, Suzanne K. S.;
• Assignee
  The United States of America as represented by the Secretary of the Air (Washington, DC)
• Published
  Nov-15-1994
• Current US Classes:
  705/11
  705/2
• Application #
  052402
• International Classes
  G06F 015/42
• Field of Search
  364/402 364/401 364/413.01
• Examiner
  Hayes; Gail O.
• Agent
  Singer; Donald J., Auton; William G.
• US Patent References:
  4667292
  4858121
  4893270
  4975840
  4992939
  5063506
  5117353
  5128860
  5212635
  5216519
  5278751
  5280425