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Care Cluster

What is a care cluster?

A care cluster is a collection of multiple claims codes, for both diagnoses and procedures, grouped using simple or complex business rules. The ultimate goal of the care cluster is to build a patient cohort, or a group of individuals who share a medical condition or other common traits. All patients in the cohort would have care clusters for the same condition or treatment, although the claims included in the care cluster may differ.

Comparing the care clusters of those within a patient cohort can highlight where adjustments should be made for future patients to provide a more seamless experience that removes extraneous procedures or testing.

How do care clusters improve healthcare?

A care cluster offers guidance for the care and support (care pathway) a patient needs during their medical treatment or recovery. This includes the different types of physicians and healthcare providers they may need to see and the treatments they may undergo.  

By analyzing care clusters, physicians and researchers can also gain insights into a medical condition’s development over time, improving their knowledge of the disease, its risk factors, and common complications. This information can then be used to improve the care provided for other patients with the same condition.