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Improving Client Outcomes, Reducing Healthcare Costs: Part II

By Shami Dugal

This is the second part of an article series on reducing healthcare costs, while ensuring individuals still stay healthy.  To read the first part of the series, click here.


Data Model

The design behind this proposal can best be represented by a set of data that needs to be maintained, and data relationships that can provide objective measurement and results.

The diagram below shows that a client may be admitted with one or more problems; with each problem having one or more goals to be achieved; each goal consisting of one or more objectives to be met; each objective requiring one or more interventions to be used, assigned to one or more staff. This “tree”, for the most part, is a pretty standard representation in a treatment plan module.

What has been added to the data model is the management of some additional tables and screens to record levels of issues and the results of interventions. Clinical staff will determine when the client has met goals related to the issues that s/he was admitted with or may have acquired, and can be discharged.


The record of treatment plans will contain a series of assessments about which interventions were successful, over what period of time and how this data can be used to improve outcomes for patients with similar issues.

While there is subjectivity within the material, if interventions can be associated with specific measurable outcomes, then the data becomes more objective and conclusions regarding likelihood of success can be developed.


Schematic of Client Data

Data for a client/episode for a treatment plan can be represented by the following schematic:

It may be possible to use a coding structure for some of the subjective data such as assets, liabilities, diagnosis and actions.

It is probably more realistic to use a judicious mix of objective data and subjective information that needs to be interpreted by attending clinical staff so that they can determine what actions to take with respect to a client’s treatment over time.



If data can be captured about the progress a client is making with respect to interventions that have been employed, and the data can be analyzed over time, the results should provide an understanding of which interventions are beneficial for what types of issues. Can the time, then, spent by clients in institutions be reduced?

The EMR, Lab and Pharmacy systems that are currently available and implemented in many healthcare organizations contain data about a client’s current and past episodes, medications, tests and treatment plans.

What is needed is some additional data within the framework of the systems already in place so that it can be recorded in a manner for interrogation and analysis. It is possible that the benefits realized may be significant for both clients and healthcare organizations.


Shami Dugal is a member of ASPA and on the SHHSA Board. He has Bachelor’s degree in Operations Research from University of Waterloo (Canada) and an MPA from Drake University (Des Moines, Iowa). He has worked in the IT industry for over 30 years including the public sector. He consults to the State of Iowa and manages several enterprise systems for them, including the Behavioral Health project. For information on his research and citations in this article, he can be reached at [email protected].


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