Source: http://www.google.com/patents/US8100829?dq=5636223
Timestamp: 2015-05-07 00:52:17
Document Index: 246973121

Matched Legal Cases: ['ART 1', 'ART 2', 'art 100', 'art 100', 'art 100', 'art 100', 'arts 100', 'art 100', 'arts 100']

Patent US8100829 - System and method for providing a health score for a patient - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inAdvanced Patent SearchPatentsA system and method for providing an indicator of a patient's health. The system may include a data module receiving data relating to a patient's health, the data including subjective data, a conversion module generating an output from the data, the output representing the patient's health, and a display...http://www.google.com/patents/US8100829?utm_source=gb-gplus-sharePatent US8100829 - System and method for providing a health score for a patientAdvanced Patent SearchPublication numberUS8100829 B2Publication typeGrantApplication numberUS 11/974,696Publication dateJan 24, 2012Filing dateOct 15, 2007Priority dateOct 13, 2006Also published asCA2666379A1, EP2073690A2, EP2073690A4, US8403847, US20090105550, US20120116180, WO2008045577A2, WO2008045577A3Publication number11974696, 974696, US 8100829 B2, US 8100829B2, US-B2-8100829, US8100829 B2, US8100829B2InventorsMichael J. Rothman, Steven I. Rothman, Daniel B. RothmanOriginal AssigneeRothman Healthcare CorporationExport CitationBiBTeX, EndNote, RefManPatent Citations (28), Non-Patent Citations (128), Referenced by (12), Classifications (19), Legal Events (5) External Links: USPTO, USPTO Assignment, EspacenetSystem and method for providing a health score for a patient
US 8100829 B2Abstract
20. The method of claim 15 wherein a reference line stored on the computer is added to the graph, the reference line representing an average health trajectory for patients who have had a same procedure or who are being treated for a same disease, so that the patient's progress can be compared to average progress. Description
One of the major problems in delivery of effective medical treatment in hospitals is the quality and continuity of patient care. A typical patient, undergoing a serious procedure in a hospital, may easily see five or more physicians during a stay, and also many nurses and other supporting personnel. Maintaining a complete medical record for each patient (�charting�) swallows huge amounts of nursing time without providing any guidance to the medical staff on how to improve the patient's care. The present state of the art in medical care within hospitals makes very little use of the medical record, which is so bulky and awkward that it can only be quickly perused by doctors on their rounds. Such reading of the chart makes it almost impossible to evaluate treatment modalities or to detect a patient's declining health in time for intervention (before a crisis).
Embodiments of the present invention provide a system and method for continually tracking the health of a patient in a hospital. At least some of the embodiments allow physicians, nurses and clinical researchers to provide more effective health care for each patient, especially those spending several days in a hospital. In addition or alternatively, at least some embodiments assist hospitals in avoiding errors and reducing crisis management by using the systems' capability to detect trends in a patient's health before the patient reaches a crisis point. Recognizing a decline soon enough to administer proper treatment may be a life-saving benefit. Embodiments of the system may give physicians and nurses a way in which to get the �big picture� of a patient's condition and absorb in a glance perhaps 100 pages of a patient's medical records. This deeper understanding, along with this new capability to detect health trends, short-term (over the space of hours) and/or long-term (over the space of days) may be important in delivery of effective medical care. Embodiments may enable a new field of scientific study, where medical and surgical treatments can be evaluated by the new measurements provided by embodiments of the present invention.
Embodiments of the present invention generate a new measurement of health, herein termed the patient �Health Score,� which may be continually plotted and displayed to show each patient's medical progress during his hospital stay. The health of the patient may relate a patient's vitality and overall quality of life rather than simply being free from disease. Although a patient who has a terminal disease, such as cancer, may conventionally be considered to be in �poor health�; however, if a cancer patient who only has a few months to live is playing ping pong for hours, he/she may be considered to be in good health, as the term is used herein. In comparison, a patient who entered the hospital to have a simple surgery, such as a tonsillectomy, may conventionally have been considered to be and will likely recover to be in �excellent health.� However, while recovering, the tonsillectomy patient's vitality might be low and his/her change of dying in the near future could be much higher if a complication were to arise; thus, the patient may be considered to be in poor health, as the term is used herein. The health of a patient may relate to the patient's overall physical, mental, spiritual and social wellbeing and not merely the absence of disease or infirmity. Embodiments of the present invention may prove to be a vital aid for improving the quality and continuity of medical care.
In one embodiment, the Health Score may be used to predict the odds of a crisis within N number of hours. That is, for example, there is a 20% chance of a crisis in the next 12 hours. This information may be used to assign additional observation to particular patients, or if a crisis is judged to be imminent, a call may be initiated to a Rapid Response Team. Another use for the Health Score is to route doctor's rounds, so that walking instructions can be provided for a doctor doing rounds. This will allow a doctor to quickly move to patients requiring more attention first, and then proceed to less critical patients. A doctor or nurse may annotate a chart, such as adding a comment, for example �Breathing well,� or a nurse could say �Tubes removed.� Charts may also be annotated by adding special ICONS . . . for example, a walking man to show that the patient is now mobile. The name of the doctor who is treating the patient may also be added to the chart.
In some embodiments, the life expectancy or mortality of a patient, such as the likelihood that a patient will die within the next 24 hours, may be predicted. For example, if a terminal patient is listed as DNR (do not resuscitate) or �keep patient comfortable,� a family member may want to know the life expectancy of the terminal patient to plan for the inevitable death.
In another possible arrangement, the Health Score may be used to determine priority and timing of the post-discharge �how are you doing� call. For example, patients leaving the hospital with favorable Heath Scores may be called in three days for a checkup, whereas patients with marginally acceptable Heath Scores may be called sooner.
In another embodiment, the Health Score chart shapes can be clustered to discover the �types� of patient health trajectories. General prototypical trajectories, or trajectories computed as a function of disease or procedure may be compared against actual Heath Score charts to determine how a particular patient is responding to treatment. Once a Health Score chart is assigned to such a prototypical trajectory, it may further indicate the likelihood of various outcomes. In some embodiments, this may be accomplished by using DRG/IRC-9 groupings, as discussed herein.
In some embodiments of the present invention, a Health Score system 10 may be provided for generating and presenting a Health Score. The Health Score may be a medical reference �figure-of-merit� that is used by a health caretaker, such as a physician, nurse or other health attendant, to track the patient's health before, during or after a medical procedure or illness, in order to assist in preventing that patient from reaching a health crisis. When used in this manner, the Health Score chart enables the attending physicians and nurses to detect trends in the patient's health over time, particularly in evaluating post-operative recovery in the hospital. It also provides a statistically significant �outcome� for both clinical studies and retrospective studies of the relative efficacies among various surgical procedures or techniques, and among medical treatments and drugs.
In some embodiments, additional data from a healthcare provider's notes may be incorporated as data. For example, a patient may have passed the respiratory standard of a nursing assessment, but the nurse may have indicated a notation of �diminished breathing capacity.� This note may be incorporated into the nursing assessment analysis or as a separate variable as not all embodiments of the present invention are intended to be limited in this respect.
Transformation module 16 may be configured to transform each of the pieces of medical data obtained from collection module 14 into a numerical quantity at step 210. The transformation performed by module 16 may include any number of mathematical or logical operations. Transformations may also take multiple inputs to produce a single transformed output. Multiple inputs may include historical data for this patient or for any given class of patients. For example, if the patient's pulse is greater then one standard deviation above that expected for a certain group of patients at this stage of their recovery, then the value of �High Pulse� is one, otherwise it is zero. An example of a transformation for diastolic blood pressure (TDBP) would be:
if diastolic blood pressure (DBP)<50, then TDBP=2; if DBP>50 and DBP<90, then TDBP=0; if DBP>89 and DBP<100, then TDBP=1; if DBP>99 then, TDBP=2.
Another example of a transformation may be for a nursing assessment. For example, if the respiration assessment equals �met standards� then the transformed respiration rate equals zero. If the nursing assessment for respiration equals �did not meet standards� then the transformed respiration rate equals one.
The following serves as an exemplary embodiment of a list of typical conversions of raw medical data into numerical form (�transformed numbers�) by transformation module 16, for use by system 10 in developing a patient Health Score:
if diastolic blood pressure<50 then Transformed Diastolic BP=2 diastolic between 50 and 89, then . . . 0 diastolic between 90 and 99, then . . . 1 diastolic>99, then . . . 2 all nursing assessments . . . Met=0 . . . or Not Met=1 multiply cardiac, neurological, pain, peripheral vascular, psychosocial, respiratory and skin/tissue assessments by 2 if Braden score<18, then . . . 1 if Braden score greater or equal to 18, then . . . 0 if systolic blood pressure<70, then . . . 3 if systolic>69 and <81, then . . . 2 if systolic>80 and less than 101, then . . . 1 if systolic>100 and <200, then . . . 0 if systolic>199, then . . . 2 if heart rate<40, then . . . 2 if heart rate>39 and <51, then . . . 1 if heart rate>50 and <101, then . . . 0 if heart rate>100 and <11, then . . . 1 if heart rate>110 and <130, then . . . 2 if heart rate>129, then . . . 3 if respiration<9, then . . . 2 if respiration>8 and <15, then . . . 0 if respiration>14 and <21, then . . . 1 if respiration>20 and <30, then . . . 2 if respiration>29, than . . . 3 if temperature<95, then . . . 2 if temperature>94 and <101.1, then . . . 0 if temperature greater or equal to 101.1, then . . . 2 If the monitored heart pattern is �atrial fibrillation�, �sinus rhythm�, �sinus tachycardia� or �paced� then . . . 1 If the monitored heart pattern is �sinus bradycardia� then . . . 2 If the monitored heart pattern is �atrial flutter� OR �heart block� then . . . 3 If the monitored heart pattern is �junctional rhythm� then . . . 4 If the monitored heart pattern is �ventricular tachycardia� then . . . 5 Or if the monitored heart pattern is �ventricular fibrillation� then . . . 5.
The above conversions of medical data into scaled numbers is geared to assessment of negative factors. However, it is understood that positive assessments may be included too, resulting in �negative� scaled numbers, that would show a positive affect on the Health Score. For example, transformation module 16 may give a negative scaled number in the event that heart rate or lung capacity or other such medical data is not only OK, but is in fact at an ideal state.
An example of a combination Health Score generated by combination module 18, using the �transformed numbers� (as described above) generated by transformation module 16 of system 10, may be:
�Health Sum�=Diastolic Blood Pressure+Temperature+Respiration+Systolic Blood Pressure+Heart Rate+Braden Score+Cardiac Assessment+Food Assessment+Gastrointestinal Assessment+Genitourinary Assessment+Heart Rhythm+Musculoskeletal Assessment+Neurological Assessment+Pain Score+Pain PART 1
Health Score=100*(30−�Health Sum�)/30 PART 2
Diastolic Blood Pressure of 95=1 Negative nursing cardiac assessment=2 Negative nursing respiratory assessment=2 Braden Score of 18=0 Systolic Blood Pressure of 202=1 Heart Rate of 100=1 Respiration Rate of 14=0 Temperature of 98=0 Heart Rhythm of sinus bradycardia=2 �Health Sum�=(totaling of all above)=9
Health Score=100*(30−�Health Sum�)/30=100*(30−9)30=70
For example, in FIG. 6, on the Health Score chart 100, the line labeled �Standard Open Heart� may be a statistical reference curve 110 of the average recovery of an open-heart surgery patient of age 80. The Health Score plot 106 labeled �Jane Smith�Room 7A� is the actual Health Score representation of the recovery of Jane Smith. One sees that although Ms. Smith has steadily improved since her operation, for the last several days she has improved at a much slower rate than would be expected when compared to average (past) patients of the same age undergoing a similar procedure. Statistical reference curves 110 can be compiled from current patients or an evaluation of past patients by using their records to generate Health Score histories.
FIG. 8 is another example of adding principal corresponding measurement curves 112 to a standard Health Score chart 100. In this example, it can be seen that the Principal Corresponding Measurement curves 112 themselves are important. The line at the bottom of the Health Score chart 100 is �pain scale� which is an evaluation of the patient's pain level. It is scaled between zero and ten. This patient is experiencing significant pain almost exactly every 24 hours. This situation may be the result of a poor pain management strategy; the patient is under-medicated until he experiences a crisis, at which time a large dosage of medication is administered. Evaluation of the chart would prompt modification of this patient's pain medication frequency and dosage.
In another embodiment, presentation and/or comparison module 20 may also alter Health Score chart 100 to obtain certain kinds of slope information. Even though trends are usually easy to spot by eye upon looking at Health Score plot 106, an automatic �simple� slope calculation may also be useful. Mathematically, this is the first derivative of the Health Score as a function of time. Due to the �noisiness� of typical Health Score plots 106, some averaging methods may be employed as well. If the slope is positive, the patient is probably getting better; if it is approximately zero, then the patient is staying the same; and if it is negative, then the patient is probably getting worse. Slope lines 116 may be added to the Health Score plot 106, as shown in FIG. 10. Such slope information may help identify trends in Health Score plot 106, particularly, when plot 106 is �noisy� due to large variations between each Health Score measurement. Although normally �staying the same� would not be considered a negative, in the situation where the patient is expected to be recuperating, �staying the same� may be quite worrisome. In the present example, although the most recent Health Scores on plot 106 are constant at about a level of 70, the slope line 116 shows a negative slope, taking into account prior points, including a time early on day 4 when the score was closer to 90.
Presentation and/or comparison module 20 of system 10 may also compute �rate of change� of the simple slope. For instance, although the patient is still getting better, the rate of improvement may be decreasing. This slow-down in recovery could be evidence of a problem just beginning to develop. Mathematically, this curvature information is the second derivative of Health Score as a function of time. Similar to the slope data 116, due to the �noisiness� of the curves, averaging is included in the computation. It is understood that attending physicians can adjust the slope calculation to include more or less reference Health Scores from plot 100 depending on the time span over which the physician intends to analyze.
When the raw data is noisy, a �running average� or other �smoothing� of the Health Score can be displayed on Health Score charts. The smoothed Health Score curve 118, shown in FIG. 10, could incorporate both the 1st derivative (slope) and/or the 2nd derivative (curvature) by color-coding or by thickness of the displayed line. For example, if the patient was getting worse (negative slope), the line might be colored red. If the patient is getting worse at an accelerating rate, or is getting better at a lessening rate, then the line could be bolded for emphasis.
As such, the above-described system 10 and accompanying generated Health Score charts 100 may provide a convenient means for monitoring patient health status, particularly in hospital post-operational situations. It may allow doctors to get a feel for the overall health of the patient and to detect trends in the patient's health. Such information is particularly useful in preventing crisis situations from arising in patients, where the worsening condition (of a patient of adequate, yet deteriorating health) is overlooked until it is too late. The creation of the Health Score chart 100, by the present invention, may help in alerting attending physicians, nurses, or �rapid response teams� to deteriorating conditions, even when a spot check of the patient's health would seem to show the patient to be in an adequate state of health.
For example, a procedure is often evaluated in terms of mortality rate, length of hospital stay, or number of re-admissions to the hospital. These measures are all significant, but at the same time are all rather crude measures. For example, if �Procedure A� has a mortality rate of 0.5% and �Procedure B� has a mortality rate of 0.7%, it may be very difficult to judge one the superior of the other, using only these mortality statistics. However, if patients discharged after Procedure A have an average Health Score of 80, and those discharged after Procedure B have an average Health Score of 60, there may be a real and meaningful difference between the two procedures in terms of overall efficacy in treating the patient. Thus, system 10 may provide a more sensitive measurement of health than any other available measure, since it is not based solely on major �outcomes� (like discharge or death), but rather on a more subtle combination of overall health factors. A medical study using the Health Score, which this invention makes readily available for every patient, may find earlier and easier and more meaningful �statistical significance� than a similar study that needed to wait for eventual mortality outcomes.
An additional feature of Health Scores generated by system 10 is that the Health Score can be used as a predictor to assist in determining which patients require the most care. Although individual symptoms and raw medical data may be varied, the amalgamated Health Score, as shown on Health Score charts 100, tends to be an accurate predictor of patient outcome. For instance, using Health Score data generated postfacto, FIG. 12 shows actual graphic correlation between Health Scores from system 10 (computed at transfer to the ICU from a regular ward of the hospital) versus the rate of predicted expiration after an ICU stay. The chart shows a precipitous decline in survival rates when the patient has, incoming to the ICU, an overall Health Score below 65. In such instances, ICU units admitting patients with Health Scores below 65 may choose to divert additional resources to these patients, in order to reduce morbidity and mortality rates. The Health Score is a sensitive new tool for the ICU use. In this example, patient �A� with a Health Score of 65, versus patient �B� with a Health Score of 75, might not exhibit obviously different symptoms, and thus the patients might be treated similarly if the Health Score were not available. But when the doctors know that there is a statistically significant decline in survival rate when the Health Score is 65, patient �A� may get the additional care that would save his life.
Furthermore, incoming Health Scores can be used as an indicator of survival rates before undergoing certain procedure. Not all patients are equal when entering the hospital for a procedure. In some cases, a decision �not to operate� may be made if the risks of complication are too great. An admission-timed Health Score from system 10 may also provide statistical information for post-operative survival rates, which could greatly influence a hospital's decision to recommend the use of surgery, versus alternative treatments.
In some embodiments, the system may allow physicians and nurses and clinical researchers to provide more effective health care for each patient, especially those spending several days in a hospital. In some embodiments, hospitals may avoid errors and reduce crisis management by using the system's ability to detect trends in a patient's health before the patient reaches a crisis point. Recognizing a serious decline soon enough to administer proper treatment may be a life-saving benefit. In some embodiments, the system may give physicians and nurses a way in which to get the �big picture� of a patient's condition and absorb in a glance perhaps 100 pages of a patient's medical records. This deeper understanding, along with this new capability to detect health trends, both short-term (over the space of hours), and long-term (over the space of days), may be important in delivery of effective medical care. In some embodiments, an entirely new field of scientific study may be enabled, where medical and surgical treatments can be evaluated by the new measurements provided by some of the systems disclosed herein
In some embodiments, a new measurement of health is generated, herein termed the patient �Health Score� which may be continually plotted and displayed to show a patient's medical progress during his/her hospital stay. Some embodiments of the present invention may prove to be a vital aid for improving the quality and continuity of medical care.
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