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PubMed1995

Design and development of a utilization review program in Portugal.

This paper describes the work that has been under way in the Portuguese government hospital sector, with respect to the use of an adapted version of the Appropriateness Evaluation Protocol (AEP). Modifications to the original system were determined through a series of experiments at pilot hospitals and reliability and user profile studies were subsequently conducted using the modified criteria. Results were of great value in terms of the identification and quantification of problems. On average, approximately one in every four non-obstetric admissions and one in every 2 days of stay were deemed inappropriate and 75% of all inappropriate days were related to patients who were ready for discharge. It is expected that the use of the modified AEP will be extended and enhanced over the next few years. In this regard, advantage has already been taken of the implementation of an output-based funding system, combining retrospective statistical analysis of the hospitals' inpatient databases with targeted reviews of individual patients.

Health Services Research↗
PubMed1993

Managed care liability for medical malpractice and utilization review.

Managed care subscribers alleging harm due to physician negligence often assert claims against their managed care plans as well. This article reviews five theories of liability under which relief has been sought and describes some of the defenses managed care organizations have raised to avoid liability.

Health Maintenance Organizations↗
PubMed1991

Smart Pharmacy Cards to automate patient records for prospective drug utilization review.

The Smart Pharmacy Card automates the patient's medical and prescription history so that every new prescription can be analyzed by a pharmacist to determine if it conflicts with disease states, allergies, prescription and non-prescription drugs documented in the card. The prototype that will be demonstrated at SCAMC 1991 will use an integrated-circuit card ("smart card") that holds 16,000 bits of electronically-erasable data.

Clinical Pharmacy Information Systems↗
PubMed1998

Reliability of a hospital utilization review method in Turkey.

OBJECTIVE: To determine whether the Appropriateness Evaluation Protocol (AEP) is reliable in Turkey. METHODS: Three reviewers, two physicians and one nurse each reviewed 196 patient-days concurrently by using the AEP at three hospitals, two of which were teaching hospitals. Inter-reviewer reliability was assessed both for all cases reviewed (overall agreement), and for only those judged inappropriate by at least one reviewer (specific agreement). In addition, overall agreement between pairs of reviewers was evaluated by the Kappa statistic. RESULTS: The overall agreement between pairs of reviewers was very high: 93.4-95.9%, and it was similar between all pairs. The level of overall agreement was highly statistically significant: k=0.725-0.833, P<0.001. The specific agreement rates ranged from a low of 61.8% to a high of 75%. CONCLUSIONS: These results show, for the first time, that the AEP method is reliable in Turkey.

Hospitals, Teaching↗
PubMed1993

Utilization review of the use of BACTEC PLUS high-volume blood culture bottles.

The BACTEC PLUS 26 (NR26) (Becton Dickinson, Towson, Md.) high-volume blood culture bottle replaced the less expensive smaller-volume NR6A bottle in our hospital. An audit carried out several months after their introduction revealed that only 17.5% of the NR26 bottles received the required blood volume. Several audits and educational programs were required in order to achieve a compliance rate of > 60%.

Bacteremia↗
PubMed1995

Comprehensive approach to utilization review based on patient-specific costing data.

The Ottawa General Hospital (OGH) is one of a growing number of institutions that has implemented a cost accounting system. The ability to track costs on a patient-specific basis provides an exciting avenue for reviewing the use of resources. With the accumulation of a complete fiscal year of data, the hospital recently embarked on a review process to identify opportunities for more detailed review with practitioners. This will support the OGH's surgical approach of targeting cuts, rather than making across-the-board reductions. The objective is to allow the hospital to maintain the highest levels of quality and service as the eroding funding situation allows. This paper describes the comprehensive approach taken by the review team to identify populations of patients that were relatively homogeneous and yet showed the greatest practice pattern variances between physicians. The method described provides a template for others to summarize large amounts of data and stratify patient groups for more detailed analysis of the patient care delivery process.

Data Collection↗
PubMed2006

Drug utilization review in an extended care facility. 1974.

Clinical pharmacy has expanded the scope of pharmaceutical services and one of the newer areas of involvement is the extended care facility. The author discusses the need, because of a limited budget, for better financial control of drug usage in Lions Gate Hospital's new 170 bed extended care unit. A need for pharmacy involvement in geriatrics because of the rising population of elderly people in extended care facilities and nursing homes and the complexities of using drugs in the elderly is discussed. The new extended care unit was provided with traditional pharmacy services and a pharmacist to participate in a patient review committee. This pharmacist monitored the patients' drug usage and made recommendations to the committee where applicable. The lowered costs of drug therapy in the extended care unit and the more efficacious use of certain medications are discussed in terms of pharmacy involvement. The author concludes that the pharmacist can make a significant contribution to the more economical use of drugs in extended care facilities and has a potential valuable role in improving patient care in this area.

Aged↗
PubMed2001

Utilization review of systemic antiinfective agents in a teaching hospital in Tehran, Iran.

OBJECTIVES: To investigate the pattern of systemic antiinfective use in Bouali teaching hospital (BH) within a standardized methodology. METHODS: To perform a standardized and repeatable study, the Anatomic-Therapeutic-Chemical classification and defined daily dose (ATC/DDD) methodology was used for the first time in Iran. The number of systemic antiinfectives (J class) prescribed for inpatients over a period of 6 months was converted to DDDs. DDD per 100 bed-days was used as a quantitative indicator, and the expenditure share of these drugs was computed. Data were compared with those of similar studies in other countries. RESULTS: Total prescription of systemic antiinfectives was 101.92 DDD/100 bed-days, of which 62% related to parenteral forms. 58% to broad-spectrum agents, and 40.2% to broad-spectrum parenteral agents. The five most commonly used drugs were ampicillin, cefazolin, ceftizoxime, gentamicin, and cefalexin. Antiinfectives prescribed for inpatients accounted for 25.2% of total drug sales of the hospital pharmacy. Most prescriptions occurred in infectious diseases ward. followed by the intensive care unit, gynecology, obstetrics, and ear-nose-throat wards. CONCLUSION: Prescribing patterns in different wards, relationships between use and cost. and monthly variations are identified and discussed. High utilization rate and irrational prescription of antiinfectives in BH, along with inadequate hospital and national drug policies may be concluded from this study. Drug utilization research study is a useful tool to highlight patterns of drug use.

Anti-Infective Agents↗
PubMed1983

Short-stay study--utilization review.

During a 6-month period approximately 20% of the 589 patients admitted to the Maryland Institute for Emergency Medical Services Systems (MIEMSS), and who did not die, stayed less than 48 hours. About two thirds of these short-stay admissions (13% of the total number of admissions during the study period) were judged inappropriate on clinical grounds. This percentage is lower than the inappropriate rate (20%) experienced at areawide trauma centers in Maryland and may approximate the lower limit of the rate of inappropriate admissions due to unavoidable errors in triage. The inappropriately admitted patients did not impose a large fiscal or service drain on MIEMSS and did not interfere with the care of patients with more serious problems.

Humans↗
PubMed1995

The effects of managed behavioral health care utilization review on hospital substance abuse detoxification.

Four groups drawn from patients in a hospital substance abuse detoxification unit were compared to determine if staff training on the basics of managed care would impact the length of the hospital stay authorized by private health insurance providers. Pre- and post-intervention groups were drawn from patients carrying the most frequently used insurance, Blue Cross/Blue Shield (BC/BS) and from patients of all other private insurance providers. Results indicate that the most frequently used provider was authorizing lengths of stay consistent with those of other private providers. However, results also indicated that significantly shorter lengths of stay were being authorized by all of the private insurance providers during the post-intervention period of the study. This study (1) confirms clinical observations showing a trend toward shorter lengths of hospital stays for patients with substance use disorders and (2) confirms that these decisions are being made primarily by insurance providers.

Blue Cross Blue Shield Insurance Plans↗