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At least 127 records · Page 7Linked to original sources
PubMed1992

Green Spring criteria for medical necessity of outpatient treatment and its use in a mental health utilization review program.

The authors have developed a two-tiered method for utilization review of outpatient mental health services. The methodology looks at initial and continued treatment evaluation and uses diagnosis, symptoms, plan of treatment, and the Global Assessment Scale (GAS) among other indicators to determine appropriateness of treatment. Preliminary program experience has been positive and is included.

Ambulatory Care↗
PubMed1977

A suggested schema for utilization review for a Community Mental Health Center.

Three record-keeping models were examined by an interdisciplinary committee at the Rochester Mental Health Center to see which would best meet the needs for a standardized record format that could be used by an outpatient comprehensive community mental health center. The systems examined were: (1) Model Criteria Set, (2) Problem Oriented Record, and (3) a Combination Diagnosis and Standardized Problem List. A modification of the Combination System used at the Cleveland Metropolitan General Hospital was developed. Using this tool, an audit committee began the process of Utilization Review. It is a suggested schema to other outpatient mental health centers who are in the process of developing a utilization review process.

Community Mental Health Services↗
PubMedDate not supplied

Medical professionalism under managed care: the pros and cons of utilization review.

We contend that the full consequences of managed care for American medicine and health care professionals can be more fully understood if strategies for managing care are identified-in particular, strategies for the administrative oversight of professional decision making. In this paper we apply this perspective to the study of third-party utilization review, making use of a national survey of firms contracting to provide prior authorization for hospitalization in 1992. Survey data suggest that (1) existing approaches to utilization review differ greatly among review firms; (2) review practices that might improve agency and accountability seem to be overlooked by most review firms; and (3) a large number of review firms employ practices that undermine professional autonomy in seemingly inappropriate ways.

Data Collection↗
PubMedDate not supplied

Case costing's contribution to utilization review activities: a review of a laparoscopic cholecystectomy patient population.

The Ottawa General Hospital is one of 13 Ontario hospitals participating in the Ontario Case Cost Project. The hospital has been collecting clinical and financial information based on the patient-specific use of products and services since April 1, 1993. The resulting decision-support database that is evolving enhances the traditional utilization review process. The author presents the analysis and conclusions regarding laparoscopic cholecystectomy patients as an example of the hospital's use of the data in utilization review activities.

Case Management↗
PubMed1996

A primer on drug utilization review.

Many health care organizations evaluate drug utilization to improve the quality of patient care, reduce pharmaceutical expenditures, and enhance therapeutic outcomes. The Drug Regimen Review, instituted in 1974 as part of a quality assurance program for the care of Medicaid recipients, has reduced medication use, medication errors, adverse drug reactions, and drug-drug interactions. The Drug Usage Evaluation, a sophisticated analysis of drugs, their uses, and their contributions to various patient outcomes, is performed by member institutions of the Joint Commission on Accreditation of Healthcare Organizations. The 1990 Omnibus Budget Reconciliation Act (OBRA '90) established the Drug Utilization Review (DUR), which was implemented by state Medicaid outpatient prescription programs in 1993. Pharmacists performing DURs must review past patterns of drug misuse, monitor current therapy, and offer patient counseling. Drug utilization reviews have reduced inappropriate drug use and decreased drug costs.

Drug Utilization Review↗
PubMed1984

Utilization review within PPS.

Requisite to managing the cost of treating medicare patients is a utilization review process that will decrease hospital risk under PPS. This review process is explained as well as the reimbursement schedules for hospital resource/cost or day outliers.

Professional Review Organizations↗
PubMed1975

Developing a utilization review model for community mental health centers.

During their struggles to develop a utilization review model for a community mental health center, members of an interdisciplinary committee identified several issues they believe are important in establishing such a model. They include comprehensiveness of participation and of areas for review (the review committee should represent all disciplines and programs, and should be concerned with any aspect of center functioning), a problem-review approach in which subcommittees carry out documented studies of issues or problems, and specific provision for feedback and implementation of the results.

Community Mental Health Services↗
PubMed1988

The development and implementation of a drug utilization review program.

In response to rising drug expenditures and pressure from hospital administration to contain drug costs, the department of pharmaceutical services at The Mississauga Hospital initiated a Drug Utilization Review (DUR) Program. The main purpose of this program was to contain the escalating drug budget through identifying and correcting areas of drug misuse, without compromising the quality of patient care. This article will describe the procedures involved in developing and implementing such a DUR program at our hospital and our experience to date. Both structured and informal strategies have been implemented, which have identified factual and potential cost savings. Overall, the DUR program has been well accepted by the medical staff and hospital administration.

Concurrent Review↗
PubMed1987

Utilization review and quality assurance: staying in the black and working with the blues.

Utilization review (UR), Quality Assurance (QA), and Peer Review (PR) have become essential aspects in the practice of general hospital psychiatry. This article first defines and elaborates the basic elements of UR, QA, and PR and then outlines the development of a program for these professionally initiated and maintained methods of problem seeking and solving as it occurred on a short-term voluntary inpatient psychiatric unit. Finally, current trends and conflicts inherent to QA, UR, and PR are discussed, with a view towards the future.

Cost Control↗
PubMed1980

Utilization review altered to advantage.

PSRO adopted a methodology in which first five days of hospitalization were exempted from utilization review. Substantial savings and expanded concurrent review resulted.

Concurrent Review↗
PubMed2006

Effect of drug utilization reviews on the quality of in-hospital prescribing: a quasi-experimental study.

BACKGROUND: Drug utilization review (DUR) programs are being conducted in Canadian hospitals with the aim of improving the appropriateness of prescriptions. However, there is little evidence of their effectiveness. The objective of this study was to assess the impact of both a retrospective and a concurrent DUR programs on the quality of in-hospital prescribing. METHODS: We conducted an interrupted time series quasi-experimental study. Using explicit criteria for quality of prescribing, the natural history of cisapride prescription was established retrospectively in three university-affiliated hospitals. A retrospective DUR was implemented in one of the hospitals, a concurrent DUR in another, whereas the third hospital served as a control. An archivist abstracted records of all patients who were prescribed cisapride during the observation period. The effect of DURs relative to the control hospital was determined by comparing estimated regression coefficients from the time series models and by testing the statistical significance using a 2-tailed Student's t test. RESULTS: The concurrent DUR program significantly improved the appropriateness of prescriptions for the indication for use whereas the retrospective DUR brought about no significant effect on the quality of prescribing. CONCLUSION: Results suggest a retrospective DUR approach may not be sufficient to improve the quality of prescribing. However, a concurrent DUR strategy, with direct feedback to prescribers seems effective and should be tested in other settings with other drugs.

Cisapride↗
PubMed1987

Albumin/hetastarch drug utilization review in an operating room pharmacy.

A prospective drug utilization review (DUR) was performed on the colloids albumin 5% and hetastarch 6% at the University of Illinois Hospital Operating Room Pharmacy. This DUR's purpose was to evaluate the usage patterns of the two colloids. With the addition of hetastarch 6% to the formulary, an alternative colloid was available that could be therapeutically substituted for albumin 5% at a cost savings. Its usage, however, was not what would have been expected. Usage information was obtained by placing utilization forms inside the individual boxes of albumin 5% and hetastarch 6%. These forms were completed by the anesthesiologists and returned to the pharmacy, where the remainder of each form was completed. It was concluded that 93 percent of the patients administered albumin 5% could have received hetastarch 6%. Hence, potential yearly savings of approximately $12,346.00 could be realized by the Department of Pharmacy.

Albumins↗
PubMed1993

Vancouver General Hospital Palliative Care Unit utilization review.

This paper describes the utilization pattern in the Palliative Care Unit at Vancouver General Hospital for a six-month period (1 April-30 September 1991) and relates the information provided to the mandate of the palliative care program. It is a retrospective study of 139 patients discharged during this period. Data were collected from the Hospital Medical Records Institute (HMRI), the Medical Records Department of Vancouver General Hospital, patients' charts, the palliative care unit admission/discharge book, and palliative care consultation statistics.

Adult↗
PubMed1995

Drug utilization review in the managed care environment.

Traditional drug use evaluation (DUE) and Medicaid drug utilization review (DUR) prototypes do not meet the needs of managed care organizations. yet, creating entirely new systems for measuring quality drug use in managed care, such as HEDIS, needlessly discards the good clinical foundations already built in the other health care settings. A better solution would be for managed care to apply its hallmark traits, namely state-of-the-art electronic data management systems, integrated health care system interchange, and strong customer communication, to make the DUR process better. A strong union between clinical criteria and sophisticated health care management can revolutionize the DUR/DUE process.

Consumer Behavior↗
PubMed1990

Toward a national strategic plan for quality assurance and utilization review education.

This article discusses the need for a national plan for quality assurance and utilization review (QA/UR) education. Six points are addressed: the rationale for planning; the developments in quality assurance urging plan creation; external pressures on the QA field; internal interests in educational program development; a beginning vision of an educational future; and strategies for realizing the future. Additional planning and policy tasks are defined.

Curriculum↗