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WO1997011635A1 - Systeme de suivi medical - Google Patents

Systeme de suivi medical Download PDF

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Publication number
WO1997011635A1
WO1997011635A1 PCT/CA1996/000654 CA9600654W WO9711635A1 WO 1997011635 A1 WO1997011635 A1 WO 1997011635A1 CA 9600654 W CA9600654 W CA 9600654W WO 9711635 A1 WO9711635 A1 WO 9711635A1
Authority
WO
WIPO (PCT)
Prior art keywords
criteria
patient
ofthe
indicative
rating
Prior art date
Application number
PCT/CA1996/000654
Other languages
English (en)
Inventor
Sven F. H. Grail
George Christodoulou
Original Assignee
Grail Sven F H
George Christodoulou
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Grail Sven F H, George Christodoulou filed Critical Grail Sven F H
Priority to AU70812/96A priority Critical patent/AU7081296A/en
Publication of WO1997011635A1 publication Critical patent/WO1997011635A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C19/00—Dental auxiliary appliances
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
    • G16H10/60—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
    • G16H20/30—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/30—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for calculating health indices; for individual health risk assessment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7271—Specific aspects of physiological measurement analysis
    • A61B5/7275—Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor

Definitions

  • the present invention relates to the delivery of health care services and in particular to methods and apparatus for monitoring the delivery of such services.
  • a number of health care services such as medical examinations, dental inspection, physiotherapy and optometry are provided on a periodic basis to monitor the status ofthe patient's health, ln this way, preventative or corrective health care may be provided as the need arises so that significant deterioration ofthe patient's health is avoided.
  • the routine examinations that are performed as part of a patient ' s overall health care program are conducted at a frequency that is dictated by experience and established procedure. For example, in the dental field routine examinations are traditionally conducted on a six-month recall frequency unless, in the experience ofthe dentist, more frequent examination is required. This, however, is done at the discretion of the dentist and conventionally a six-month recall period has been established by default.
  • the present invention provides a method and apparatus by which an appropriate frequency of periodic treatment for patients is determined by scores or ratings assigned to selected criteria in a routine examination in which each ofthe criteria are weighted. The weighting and rating are combined to provide an overall indication ofthe status ofthe patient's health for the selected criteria. The weighted l o results are then compared to established ranges of results and a recall frequency selected which is appropriate for the status ofthe individual patient.
  • test results may be specially weighted so that a critically identified patients' needs can be accommodated in a minimum recall period.
  • Figure 1 is a table showing the weighting of a typical set of criteria
  • Figure's 2.1 - 2.4 are flowcharts showing the computation ofthe results for a patient
  • Figure 3 is a block diagram of a general purpose computer programmed 20 according to an embodiment ofthe present invention.
  • Figure 4 is flowchart showing a sequence of steps for entering criteria and their corresponding weighting factors
  • Figure 5 is a flowchart showing a sequence of steps for entering and computing the cumulative rating
  • 25 Figure 6 is a sequence of steps showing the input of recall frequency ranges
  • Figure 7 is a flowchart showing the selection of a specific recall frequency.
  • a routine examination in the example given, a dental examination
  • Each criteria 10 may be assessed by a standardized test that provides quantifiable results upon which an assessment may be based. Such tests may be performed by the dentist or may be performed offsite in a laboratory.
  • the criteria are split into two groups 12,14, those associated with the hard tissue and those associated with the soft tissue respectively.
  • each ofthe criteria caries a weighting based upon the significance or relative contribution that should be attributed to each ofthe criteria in the overall evaluation ofthe health ofthe patient.
  • the group of criteria 12 associated with the hard tissue provide 50% ofthe weighting and those 14 associated with the soft tissue also provide 50%.
  • the hard tissue tests 12 each carry a certain weighting so that, for example, the caries screen can contribute a maximum of 10% ofthe total evaluation, the number of fillings a maximum of 6%, and so on as shown in the "Total" column. These maximum weightings are selected from clinical evaluation such as that mentioned in the introduction and similar studies that indicate the effect of individual conditions upon the overall status.
  • criteria are established that determine the rank 18 to be accorded to the actual results ofthe tests and which will in turn determine the value or rating 20 to be attributed to the total.
  • three possible ranks 18 are attributed - namely low, moderate or high - which are consistent with the ranking of results that would be obtained from such a test.
  • a value 20 is associated with each ofthe tests so that, for example, a desirable low result caries screen provides in this example a 10% value whereas a moderate result achieves only a 5% value.
  • the value associated with the rank is then retained as a value which will be accumulated into the total.
  • the number of fillings - can be evaluated directly by the dentist and again ranks based on prior studies are used to determine the value that should be attributed to that particular test.
  • a maximum value is attributed to less than 6 fillings
  • a moderate value is attributed to an examination that yields between 7-12 fillings
  • a minimum value is attributed to more than 12.
  • the criteria selected may also attribute a rank and corresponding weighted value based upon the prior history such as the last tooth decay which accords a higher value as the period from the last detected tooth decay increases.
  • the patient's own history may be taken into account by according a high value to frequent dental visits and a low value to infrequent visits. It will be noted that these values are used to counterbalance an ambiguous test result - for example, an apparently good tooth decay history - so that a high value attributed to the prolonged period from the last detected tooth decay is counterbalanced by the fact that the patient has not visited the dentist during that period. 5 Tests may also be included that rank the patient's own habits such as the amount of plaque present indicating whether or not the patient is performing an effective oral hygiene routine.
  • the age ofthe patient may be taken into l o consideration.
  • a 13-year-old with four filled teeth would have a higher risk than a 55-year-old having only two fillings.
  • the assigned rating should take into consideration the age ofthe patient.
  • the distributions ofthe number of decayed, number of missing and number of filled teeth by age group is determined. For each age group, appropriate 15 percentiles are determined - for example, the worst (highest) 25%, the next worst 25%, the next to best 25% and the best (lowest) 25% - is determined.
  • a value is thus accorded to each ofthe criteria and those values accumulated to provide a subtotal for the hard tissue inspection as a percentage of an overall score.
  • the soft tissue inspection criteria 14 are considered more critical and in the example given consists of a periodontal screening test (PSR).
  • PSR tests provides a score from 1 through 5 with 1 considered good and 5 considered bad. Such a test is in fact a cumulative score based upon the inspection of any pockets at the gum line.
  • the PSR test is structured so that a pocket in excess of a predetermined depth, typically 5 mm, 30 produces a maximum score, ie. a 5, and is considered sufficiently critical to require immediate corrective measures. Accordingly, on the soft tissue criteria 14, a PSR test of 5 is given a minimum value whereas a PSR test of 1 is given a maximum value.
  • the values obtained from each test are totaled to determine a cumulative score and that score is then compared with a set of predetermined ranges of values, as for example shown in Figure 1, are correlated to particular recall frequencies for the patient.
  • a score of between 0 and 50 would indicate that a frequent examination is required and attribute a suggested three-month recall frequency.
  • a score of between 51 and 69 would indicate that a six-month recall would be appropriate, with other values indicating that extended periods would be appropriate. Based on the results of the set of tests, therefore, an appropriate recall interval can be attributed based upon prior evaluations ofthe overall dental health ofthe patient.
  • the values associated with it can be weighted such that a minimum recall period is automatically obtained. For example, with the PSR test, a score of 5 ensures that the total score cannot exceed 50% and therefore a three-month recall is inevitable.
  • the method of evaluating the recall frequency may be automated for inclusion in the overall records system ofthe practitioner as shown in the flowchart of Figure 2.
  • Data entry could be completed in any convenient manner, including a hand-held unit that interfaces with a central records system or a terminal on a LAN.
  • a particularly beneficial data input technique utilizes the interfaces available from commercially available medical maintenance systems, such as that sold as Dentrix 5.0 and available from Dentrix Dental Systems Inc. of American Fork, Utah.
  • Such systems provide a graphical user interface (GUI) to record the results of a routine examination along with treatment history and personal information.
  • GUI graphical user interface
  • an evaluation routine is performed.
  • the total evaluation is stored as a cumulative value x which is initially set out at 0 and a determination is made whether optional tests have been performed.
  • the existence or otherwise of a caries test is indicated at item 1 10 and if no such test has been conducted, as determined from an appropriate field in the database, then a minimal score is attributed. If a test has been conducted, the results of that test are evaluated and the appropriate cumulative value registered.
  • the next criteria evaluated is the number of fillings which is then entered at box 112 and an appropriate score attributed to the result of that test to accumulate in the register.
  • the number of fillings may be entered manually or may be derived from the number from the symbols used on the GUI to indicate fillings.
  • Access may then be made to the patient's dental history as indicated at 118 to determine when the last tooth decay was detected and the period between such decay and the date ofthe inspection computed. Based on that calculated date, the interval from the last decay is computed 120 and the appropriate value added to the total.
  • Similar processing is applied to the balance ofthe tests through a compliance loop 122 and PSR loop 124 and the accumulated total x compared with the targeted ranges at 126.
  • the appropriate recall period is then selected and, if appropriate, can interface with the dental appointment calendar to provide a suggested appointment date as indicated at 130.
  • the step wise evaluation allows the preparation of a custom report to the patient indicating specific regimes that may be implemented by the patient.
  • This facility is indicated in Figure 2 with dashed lines.
  • a medium result from the caries test selects a standard paragraph, indicated at 132, detailing a regime that would improve the caries test.
  • Similar paragraphs are associated with selected tests and, upon completion ofthe evaluation, the selected paragraphs are consolidated into a reporting letter 134.
  • the criteria and weighting set out in Figure 1 and implemented in Figure 2 are of course exemplary. A more comprehensive set of criteria and weighting may be evaluated. For example, the number of criteria chosen may be increased or decreased depending upon the needs ofthe specific circumstances. Also, as shown in Figure 1 , the weighting applied to each ofthe criteria ie. 6% 21 for the criterion "number of fillings" 22 provides a scoring scale of 2 to 6 against which the patient is rated. It may therefore be seen that the scoring scale already takes into account the weighting of that criterion. In this case, whereas it may be implemented as a further embodiment ofthe invention, a fixed scale for all criteria, e.g.
  • each ofthe ratings would have to be multiplied by the respective weighting factor of their corresponding criteria.
  • a non-linear weighting function may be applied to the criteria and/or the rating. This may be of use - for example, in a situation where a low rating for a particular criterion is less important than a medium or high rating.
  • a suitable set of criteria can be selected which are indicative of the overall health ofthe patient and an appropriate weighting applied which can be accumulated to indicate a recall frequency.
  • criteria such as blood pressure, heart rate, urine analysis, blood analysis, patient's weight, lung capacity, height and age may be monitored and appropriate measures applied to indicate the overall well-being.
  • Existing conditions might also be included and might act as a criticality that requires a minimum recall.
  • family history may be included and weighted in an appropriate manner.
  • the criteria might include the flexibility, mobility, pain, range of movement, inflammation, medication and the time since the occurrence ofthe injury which are combined with appropriate weighting to provide a cumulative total upon which recall frequency can be evaluated.
  • FIG. 3 a general block diagram for implementing the apparatus for determining the recall frequency, as shown generally by numeral 440.
  • the device has a keyboard input 442 for providing user data input to a processor 444.
  • the processor includes a memory storage means 446 for storing criteria and their corresponding weighting factors and for storing ratings 450.
  • a display 452 is connected to the processor for displaying results of computations performed by the processor 444.
  • a data interface 454 connected with the processor 444 provides a data connection to an external program (not shown).
  • Figures 4, 5, 6 and 7 indicate flowcharts for performing a sequence of steps for programming a general purpose computer shown in Figure 3.
  • a series of criteria are input. These criteria may be determined as described earlier.
  • a weighting factor is determined as also outlined earlier. Generally speaking this weighting factor determines the relative importance of this criteria in relation to the other criteria. Thus if a criterion is considered more important than the other criteria it may be given a much higher weighting factor than the other criteria.
  • a patient is evaluated against each ofthe stored criteria.
  • a rating scale of 0 to 100 may be chosen.
  • An appropriate rating is assigned for a particular criterion.
  • This rating may then be multiplied by the weighting factor for that criterion, thus producing a weighted rating which takes into account the relative importance of that particular criterion in relation to the other criteria.
  • a non-linear weighting may be applied. In either case, the weighted ratings are then accumulated to provide a total score of cumulative ratings for the patient.
  • a set of recall frequencies are created , in which each recall frequency corresponds to a range of cumulative ratings.

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  • Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Medical Informatics (AREA)
  • Engineering & Computer Science (AREA)
  • Epidemiology (AREA)
  • Primary Health Care (AREA)
  • Biophysics (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Pathology (AREA)
  • Biomedical Technology (AREA)
  • Physics & Mathematics (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Data Mining & Analysis (AREA)
  • Databases & Information Systems (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Dentistry (AREA)
  • Dental Tools And Instruments Or Auxiliary Dental Instruments (AREA)

Abstract

L'invention concerne un système de suivi pour les soins de santé, et en particulier un procédé de contrôle du suivi pour ces soins. Le procédé et le dispositif en question permettent de déterminer une séquence appropriée pour les traitements périodiques, en fonction de points ou de notes que l'on attribue à des critères préétablis au cours d'un examen de routine. Les critères, tous pondérés, sont représentatifs de l'état de santé du patient. Chaque note est associée à son coefficient de pondération correspondante, le total des notes permettant d'établir un décompte global pour le patient. On compare ce décompte à une série de résultats prédéterminés correspondant à des soins de santé spécifiques, ce qui donne par exemple la fréquence des contrôles à respecter pour les soins dentaires.
PCT/CA1996/000654 1995-09-28 1996-09-27 Systeme de suivi medical WO1997011635A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU70812/96A AU7081296A (en) 1995-09-28 1996-09-27 Medical record system

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US445595P 1995-09-28 1995-09-28
US60/004,455 1995-09-28

Publications (1)

Publication Number Publication Date
WO1997011635A1 true WO1997011635A1 (fr) 1997-04-03

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/CA1996/000654 WO1997011635A1 (fr) 1995-09-28 1996-09-27 Systeme de suivi medical

Country Status (3)

Country Link
AU (1) AU7081296A (fr)
CA (1) CA2232686A1 (fr)
WO (1) WO1997011635A1 (fr)

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2001097685A1 (fr) * 2000-06-19 2001-12-27 Tangram-Odis S.R.L. Systeme de diagnostic monobloc destine a la cavite orale
US6356873B1 (en) * 1998-04-02 2002-03-12 Merck-Medco Managed Care, Llc Computer implemented patient medication review system and process for the managed care, health care and/or pharmacy industry
US6694298B1 (en) 1998-04-02 2004-02-17 Medco Health Solutions, Inc. Computer implemented patient medication review system and process for the managed care, health care and/or pharmacy industry
EP1192896A4 (fr) * 1999-06-04 2005-03-09 Sunstar Inc Tableau de reduction des risques, son procede de creation, programme de soins comprenant ce tableau de reduction des risques, et systeme de gestion des soins
WO2006055757A3 (fr) * 2004-11-18 2007-03-08 Dental Medicine America Llc Procede pour decrire un etat de parodontopathie
US7493264B1 (en) 2001-06-11 2009-02-17 Medco Health Solutions, Inc, Method of care assessment and health management

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5018067A (en) * 1987-01-12 1991-05-21 Iameter Incorporated Apparatus and method for improved estimation of health resource consumption through use of diagnostic and/or procedure grouping and severity of illness indicators
WO1994000817A1 (fr) * 1992-06-22 1994-01-06 Health Risk Management, Inc. Systeme de gestion de soins de sante
WO1994004072A1 (fr) * 1992-08-21 1994-03-03 Brill Peter L Procede et appareil de mesure de resultat de psychotherapie
WO1995019604A2 (fr) * 1994-01-10 1995-07-20 Informed Access Systems, Inc. Systeme et procede de gestion d'un reseau medical
US5453009A (en) * 1993-12-29 1995-09-26 Feldman; Yasha Method of and system for dental treatment

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5018067A (en) * 1987-01-12 1991-05-21 Iameter Incorporated Apparatus and method for improved estimation of health resource consumption through use of diagnostic and/or procedure grouping and severity of illness indicators
WO1994000817A1 (fr) * 1992-06-22 1994-01-06 Health Risk Management, Inc. Systeme de gestion de soins de sante
WO1994004072A1 (fr) * 1992-08-21 1994-03-03 Brill Peter L Procede et appareil de mesure de resultat de psychotherapie
US5453009A (en) * 1993-12-29 1995-09-26 Feldman; Yasha Method of and system for dental treatment
WO1995019604A2 (fr) * 1994-01-10 1995-07-20 Informed Access Systems, Inc. Systeme et procede de gestion d'un reseau medical

Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6356873B1 (en) * 1998-04-02 2002-03-12 Merck-Medco Managed Care, Llc Computer implemented patient medication review system and process for the managed care, health care and/or pharmacy industry
US6694298B1 (en) 1998-04-02 2004-02-17 Medco Health Solutions, Inc. Computer implemented patient medication review system and process for the managed care, health care and/or pharmacy industry
EP1192896A4 (fr) * 1999-06-04 2005-03-09 Sunstar Inc Tableau de reduction des risques, son procede de creation, programme de soins comprenant ce tableau de reduction des risques, et systeme de gestion des soins
WO2001097685A1 (fr) * 2000-06-19 2001-12-27 Tangram-Odis S.R.L. Systeme de diagnostic monobloc destine a la cavite orale
US7493264B1 (en) 2001-06-11 2009-02-17 Medco Health Solutions, Inc, Method of care assessment and health management
US8032398B1 (en) 2001-06-11 2011-10-04 Medco Health Solutions Inc. Care assessment tool for health management
WO2006055757A3 (fr) * 2004-11-18 2007-03-08 Dental Medicine America Llc Procede pour decrire un etat de parodontopathie
US8267689B2 (en) 2004-11-18 2012-09-18 PreViser Corporation Describing a periodontal disease state

Also Published As

Publication number Publication date
CA2232686A1 (fr) 1997-04-03
AU7081296A (en) 1997-04-17

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