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PubMed1981

Internal standards: rationale for use in a drug utilization review program.

The comparison of drug usage data gathered from different institutions would be easier if standardized criteria were employed. There are, however, major difficulties encountered in gaining approval of such criteria from different physician groups. To facilitate the criteria approval process, "internal standards" were developed. These internal standards reflected the acceptable deviations from the standardized criteria, hence, permitting flexibility for innovation in drug therapy. A retrospective drug utilization review was conducted in two hospitals. The internal standards assigned were very similar to the 0 percent-100 percent standards recommended by InterQual except for the criteria on monitoring parameters and duration of therapy. It would appear from these preliminary results that the assignment of internal standards enhances the use of standardized criteria which, in turn, will allow comparisons of data.

Cefazolin↗

PubMed1981

Utilization review in nursing homes: making implicit level-of-care judgments explicit.

Comprehensive data on 3,579 patients in Baltimore nursing homes were collected by trained teams of reliable observers. The data included an implicit judgment about the level of care (LOC) deemed most appropriate for each patient. Two different approaches were used to fit the patient data to the LOC judgments: Several versions of an algorithm adapted from a utilization review scheme based on simple clinical criteria and a series of mathematical equations based on logistic regression were each tested. In the case of the latter, each equation was derived from a random half of the data and tested on the remaining half. Both approaches yielded comparable results. The best variation of the algorithm correctly identified 71 per cent of patients needing skilled care and 69 per cent of those needing unskilled care. The equations based on the logistic regressions could correctly classify 86 per cent of those needing skilled care and 63 per cent of those not needing such care. Further improvements in accuracy of prediction on one group came at the cost of less accurate identification of the other. In general, the simplest models proved the most useful. These techniques are recommended as useful for preliminary screening of nursing home patients for appropriate LOC but should not be used as a basis for final judgments. The advantages offered by this approach are the reduction of workload demands for skilled professional judgment and the availability of a very reliable preliminary screening judgment in a highly politicized atmosphere.

Activities of Daily Living↗

PubMed2006

Drug utilization review across jurisdictions--a reality or still a distant dream?

OBJECTIVE: There is a perception that many drug usage evaluations do not widely influence prescribing behaviour. The aim of this study was to critically evaluate recent journal articles which fit the Medline definition for Drug Utilization Review (DUR) and which also cover multiple healthcare sites. METHODS: PubMed (National Library of Medicine, NLM) (2003, 2004) was searched using the MeSH topic 'drug utilization'. Retrieved studies were evaluated to ascertain those describing a DUR (measuring drug use against specific criteria). These were subdivided according to whether the DUR was conducted at one site or across many. The multi-centre DURs were critically reviewed, including evaluating whether all phases of a quality cycle were completed and determining aspects of design such as whether the study was prospective or retrospective, any interventions conducted and provision of feedback. RESULTS: A total of 646 unique articles were retrieved. Of these, 495 (77%) did not meet the definition for DUR, while 151 (23%) articles did. Thirty-five (5%) described English language multi-centre DURs; ethics approval was obtained in ten of these and 18 were carried out retrospectively. In all 35 studies some comparator or standard was used, but only eight conducted an intervention and only three provided feedback to the prescribers. CONCLUSION: Most DURs were not conducted across a number of centres. Of the recent published multi-centre DURs most presented only an initial audit and did not complete the quality cycle with feedback, intervention and re-audit. To widely influence prescribing behaviour, the full cycle is required with involvement of as many sites as possible to achieve improvements across many jurisdictions.

Bibliometrics↗

PubMedDate not supplied

Construction of the Korea Elderly Pharmacoepidemiologic Cohort: drug utilization review of cephalosporins in geriatric inpatients.

We performed a cohort-based pharmacoepidemiologic study in order to evaluate the pattern of cephalosporin prescriptions in elderly inpatients in Korea. The Korea Elderly Pharmacoepidemiologic Cohort was composed of a geriatric population of beneficiaries of the Korea Medical Insurance Corporation residing in Busan in 1993. The cohort consisted of 23,649 members, comprising 15,221 women (64.4%) and 8428 men (35.6%). The study population for drug utilization review consisted of those cohort members who were admitted into hospitals during the period January 1993 through December 1994. The number of hospitalized patients was 4262, comprising 2631 women (61.7%) and 1681 men (38.3%). The trend of cephalosporin prescriptions over the 2-year period showed that the use of second and third generation cephalosporins increased relative to the use of first generation. The use of cephalosporins combined with other antibiotics was found to occur in 22.8% aminoglycosides (76.7%) and quinolones (17.1%) being the most common antibiotics combined with cephalosporins. Our result demonstrates an increase in the prescription of second and third generation cephalosporins in Korea, which has implications not only for the elderly population but also for the total population because of the impact on health care costs and the potential for the emergence of antimicrobial resistance.

Age Factors↗

PubMed1976

Utilization review: P.S.R.O. and the oral surgeon.

The P.S.R.O. program is being implemented to improve the quality of care through effective peer review. Effective peer review requires that the oral surgeon must not only detect problems, but analyze causes and develop, implement, and evaluate corrective programs. To actively participate in development of P.S.R.O. criteria for admission, the Department of Oral Surgery at the University of Tennessee Memorial Hospital, Knoxville, conducted a restrospective survey of oral surgery admissions. Utilization review of the oral surgery admissions was conducted to determine the average length of stay and the utilization of the operating room and the ambulatory surgery clinic for patients admitted to the hospital.

Dental Care↗

PubMed1993

Nursing and self-care theory applied to utilization review: concepts and cases.

The following article demonstrates how Dorothea Orem's Self-Care Theory of Nursing serves as a theoretical framework for the hospital-based utilization review process. Orem's theory is a popular and practical one which dovetails beautifully with the goals of any department of utilization management.

Concurrent Review↗

PubMed1989

Quality assurance and utilization review in a health insuring organization. The HealthPASS example.

HealthPASS is a Philadelphia-based health insurance organization (HIO), owned and operated by the Penn Health Corporation, a subsidiary of Maxicare, the large for-profit health maintenance organization (HMO) company based in California. In a contractual agreement with the Pennsylvania Department of Public Welfare (DPW), Maxicare contracts primary care physician services on a capitated basis, and other services on a fee basis, to about 96,000 Medicaid enrollees in certain zip codes in Philadelphia. Although HealthPASS does not provide care directly, it contracts with providers for these medical services. HealthPASS serves a primarily poor, minority, and inner city population with high rates of drug abuse, alcoholism, and mental illness. Currently, the enrollees are served by a network of providers including more than 40 participating hospitals and over 500 primary care providers (PCPs) in the community. HealthPASS is unique as previous HIOs in Kentucky and Arizona both failed. This paper describes the quality assurance and utilization review (QA-UR) system implemented by HealthPASS with specific examples of case discussions and a detailed look at the structure and function of the internal review process. Before outlining the QA-UR system, a brief history is provided of the recent controversial trend toward managed care for Medicaid recipients, as there have been marked failures in this arena nationally. The HealthPASS system is described--what it is, how it is staffed, who it serves, and the health services it offers.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Maintenance Organizations↗

PubMed1988

Total parenteral nutrition: a concurrent drug utilization review.

University Hospital, a 428-bed tertiary care teaching hospital, treats approximately 150 patients annually with TPN. Currently used are three standard TPN base formulae which are ordered by physicians using preprinted TPN order forms. A concurrent Drug Utilization Review (DUR) was conducted on TPN treatment of 30 patients, to examine adherence to the current TPN protocol. Criteria for evaluation included ruling out enteral feeding, indications for TPN use, duration of therapy, monitoring of laboratory values, and caloric delivery. Physician and dietician estimation of caloric needs were compared to calories actually ordered by the physician. The number of pharmacist interventions and TPN bags wasted were also determined. Results could not be obtained with respect to ruling out enteral feeding and indications for TPN therapy due to inadequate information. The five-day minimum for duration of TPN therapy established in the DUR criteria was not attained in 23 percent (7/30) of patients. Seventy-seven percent of laboratory monitoring tests were completed. Results indicate wide disparities in caloric calculation and delivery; only 45 percent (10/22) of the patients who were ordered TPN met the physician's caloric goal. A number of recommendations were made to improve the TPN protocol and TPN therapy.

Adult↗

PubMedDate not supplied

Medicaid drug utilization review annual reports for federal fiscal year 1999: looking back to move forward.

OBJECTIVE: To review states' Medicaid drug utilization (DUR) annual reports for federal fiscal year (FFY) 1999 to assess the usefulness of the information provided in assisting states in improving their DUR programs. DATA SOURCES: Medicaid DUR annual reports from 43 states and the District of Columbia. DATA EXTRACTION: Five DUR experts conducted in-depth reviews of the annual reports to determine whether states provided the information required by the Health Care Financing Administration (HCFA; now the Centers for Medicare & Medicaid Services) annual report instructions, to assess the usefulness of information provided by states to other states seeking to improve their programs, and to consider what changes in report content are needed to increase the value of the reports. DATA SYNTHESIS: States provided the information requested by HCFA, but such information was not particularly useful in helping other states improve their programs, nor was it easily available to other states. These reports need to be reoriented. Rather than instruments useful for compliance monitoring, the reports should be remade as tools useful for educating DUR program staff. To do this, changes in report content are needed, and individual states should have access to reports from all states. Specific recommendations made based on these findings would be important first steps in improving the effectiveness of DUR programs. CONCLUSION: Much room for improvement remains in the content and distribution of Medicaid DUR annual reports. Finding ways to improve the effectiveness of DUR is especially important as the nation moves to implement a Medicare prescription drug benefit.

Annual Reports as Topic↗

PubMed1985

Drug utilization review: dipyridamole plus aspirin antiplatelet therapy.

To assess whether dipyridamole was being used appropriately in providing antiplatelet therapy at the San Diego VAMC, a drug utilization review was conducted. Concomitant aspirin therapy was required for dipyridamole to be considered effective in the disease states reviewed. Seventy-three patients on antiplatelet therapy were evaluated, using dosing criteria established through a literature review. Our data indicated tht based on the criteria, only 11% of patients received dipyridamole in appropriate doses; it was underdosed in 89% of patients, and in 19% of patients, it was used when not indicated. In addition, 19% of patients did not receive concomitant aspirin therapy. Results suggest hat dipyridamole is not used optimally in providing antiplatelet therapy to patients in this institution.

Aspirin↗

PubMed1981

A blueprint for antibiotic utilization review.

Antibiotic usage recently has come under careful scrutiny because of its impact upon hospital costs and its effect upon patient care. This article describes the antibiotic utilization review program developed at Norton-Children's Hospitals, Louisville, to improve antibiotic prescribing and to meet the requirements of the Joint Commission on Accreditation of Hospitals.

Anti-Bacterial Agents↗

PubMed1997

Eliminating unnecessary lactate dehydrogenase testing. A utilization review study and national survey.

BACKGROUND: Consensus recommendations call for the elimination of lactate dehydrogenase (LDH) tests from routine rule out myocardial infarction (ROMI) protocols. METHODS: We conducted a utilization review project in which we evaluated the institutional impact of removing LDH and LDH isoenzyme tests from our hospital diagnostic panel. We then conducted a scripted telephone survey of 100 US hospitals to assess the generalizability of this project. RESULTS: All our cardiology staff members supported this intervention. Lactate dehydrogenase isoenzyme test results did not add clinically useful data for any of 200 consecutive patients discharged with a diagnosis of acute myocardial infarction, and selective use of LDH isoenzyme testing in cases where it was clinically believed to be indicated cut costs 99% during the year after our intervention. Furthermore, our telephone survey demonstrated that 66% of US hospitals polled continue to test for LDH isoenzymes in every patient with possible myocardial infarction. CONCLUSIONS: Our results corroborate prior recommendations for the removal of LDH testing from the routine ROMI protocol. Such an intervention may be accomplished easily, with excellent staff acceptance and considerable savings. Most US hospitals continue to include LDH testing in their ROMI panels despite national guidelines recommending otherwise.

Clinical Enzyme Tests↗

PubMed1981