PSROs may modify review to focus on identified problems.
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Concurrent Review↗
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Results for “Utilization Review”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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Department review: a PSRO approach from the hospital's perspective.
The following article is the first in a two-part series which describes a departmental review system developed by the Area VII Professional Standards Review Organization (PSRO) in Ann Arbor, Michigan. In part one, an overview of the general approach to departmental review is presented. In part two, which will be published in a future issue of the QRB, application of some aspects of the system to a specific department--diagnostic radiology--will be presented. Although developed by the staff of a PSRO, the approach to departmental review described envisions such review as a delegated activity to be conducted on an individual hospital basis.
Goals↗
Regional results of acute appendicitis care.
In 1978, acute appendicitis care was reviewed by studying 2,375 cases from 74% of all hospitals in Wisconsin outside the greater Milwaukee area. The mortality was 0.17% and the wound complication rate was 5.3%. A normal appendix report was noted in 14% of all cases; female patients accounted for 60% of these cases, and only 44.5% of the total study population. The rupture or perforation rate was 13.4%; 62% of these problems occurred in male patients. The mean hospital stay was 5.4 days; for perforated cases, it was 10.2 days. An analysis that compared hospitals by their individual ratios of normal appendices to perforations favors the conclusion that a small but real decrease in negative appendectomy rates could be achieved without producing more ruptures or perforations.
Acute Disease↗
The physician advisor: genesis and rules.
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Georgia↗
UR/PSRO long term care data system.
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Computers↗
Hospital quality review can outdo PSRO external review systems.
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California↗
Leukocyte Enzymes in birth defects- a review.
The utilization of peripheral leukocytes, mixed preparations or specific populations for the detection of homozygous and heterozygous states of inborn errors of metabolism via enzyme assay or detection of accumulated metabolites are reviewed. Additionally, present knowledge of metabolic activities in leukocyte populations and areas of potentially fruitful investigation are discussed.
Amino Acids↗
Normal saline instillation before suctioning: helpful or harmful? A review of the literature.
This research utilization paper reviews the body of published literature on the practice of normal saline instillation before endotracheal suctioning of mechanically ventilated adult patients. Although normal saline instillation before suctioning is a common clinical practice, the research literature does not demonstrate any physiologic benefit to this procedure. Moreover, normal saline instillation may decrease oxygen saturation values (via pulse oximetry) after suctioning. The relevant research studies have been inconsistent and inconclusive because of limitations in sample size and research methodology. Further research studies using larger, more diverse samples, adhering strictly to recommended guidelines for endotracheal suctioning, and examining additional physiologic parameters of oxygenation are necessary. In addition, long-term outcomes of normal saline instillation such as respiratory infection and complications, as well as atelectasis, should be evaluated. Until scientific data can be presented to support the physiologic benefit of this practice, normal saline instillation should be discontinued as a routine or standard practice.
Adult↗
Microbial models of mammalian metabolism of xenobiotics: An updated review.
The utilization of microbes as models for mammalian metabolism of xenobiotics has been well established since the concept was first introduced by Smith and Rosazza in the early seventies. The core assumption of this concept rests on the fact that fungi are eukaryotic organisms that possess metabolizing enzyme systems similar to those present in mammalian systems. Hence, the outcome of xenobiotic metabolism in both systems is expected to be similar, if not identical, and, thus, fungi can be used to predict the outcome of mammalian metabolism of various xenobiotics, including drugs. Utilizing microbial models offers a number of advantages over the use of animals in metabolism studies, mainly reduction in use of animals, ease of setup and manipulation, higher yield and diversity of metabolite production, and lower cost of production. In a continuation to our contribution to this field, this review will outline the results of studies that were conducted over the last seven years to emphasize the similarities between the microbial and mammalian metabolic pathways of xenobiotics through the endorsement of the concept of microbial models of mammalian metabolism .
Animals↗
Glycosylated haemoglobins: biochemical evaluation and clinical utility.
A review is given of the biochemical background of the glycosylated haemoglobins, their methods of determination, and their clinical significance. Special attention is paid to the sample preparation. For all methods except the colorimetric TBA-method, the removal of the labile pre-HbA1c fraction is essential. Under proper conditions, high-performance liquid chromatography, agar-gel electrophoresis and affinity chromatography are suitable methods for use in the clinical laboratory for the estimation of HbA1c and HbA1. However, the colorimetric TBA-method must be considered to be the method of choice. The clinical utility of the test is stressed with special respect to the management of diabetic pregnancies, the control of home-monitoring of blood glucose, and the objective measurement of the effect of changing diabetic therapy.
Adult↗
Forecasting systems in managing hospital services demand: a review of applicability and a measure of utility.
A comprehensive literature review of forecasting methodologies and their specific applications to managing hospital services demand provided a credible base for the ensuing study of current forecasting usage. A sample of 40 hospitals was analyzed to measure the current perceived urgency to utilize forecasting systems. These findings were then compared with perceived actual usage. The incidence of formal forecasting systems actually being utilized was lower than the perceived need to use such systems. Identification of principal methodologies utilized and an assessment of computer-assisted forecasting indicated that a strong reliance on qualitative, manually-derived methodologies still remains. Correlation analyses of key exogenous variables indicated that the larger sized hospitals utilized computerized methodologies and had the highest measures of perceived need for, and actual practice of, formal forecasting programs.
Evaluation Studies as Topic↗
Medication use review process and information systems utilized for oncology chemotherapy quality improvement.
Fatal chemotherapy overdoses at prestigious institutions have prompted extensive reviews of policies and procedures in medical centers throughout the country. Improving medication use systems for chemotherapy requires a comprehensive multidisciplinary approach. A process to develop a medical center policy on chemotherapy based on the medication use model adopted by the Joint Commission on Accreditation of Healthcare Organizations will be discussed. This will include the prescribing, preparing, dispensing, administering, and monitoring process as well as quality improvement systems. Pharmacy information systems enhancements that safeguard patients are also discussed including maximum dose checks and specific dosing algorithms for bone marrow transplant patients.
Antineoplastic Agents↗
Radioimmunodetection and radioimmunotherapy of malignant melanoma. A review.
Radioimmunodetection utilizing monoclonal antibodies to various melanoma-associated surface antigens has been studied by several investigators during the past ten years. In the early trials, antibodies were labeled with 131I or 111In, but now 99mTc is almost exclusively used because of its more favorable energy for gamma camera imaging. Excellent specificity has been achieved in most studies, whereas sensitivity has been less good. In a recent European multicenter study on 493 patients sensitivity was 79% and specificity 96%. In this largest study on melanoma so far performed many previously unknown metastatic deposits were identified indicating that radioimmunodetection has a role in the management of metastatic disease. The clinical utility of immunoscintigraphy in localization of regional lymph node metastases has been documented in several investigations in recent years, indicating that this method can be used in the preoperative evaluation of patients. Radioimmunodetection has also been successfully used in the differential diagnosis of ocular lesions. However, conclusive evidence of improved patient outcome resulting from the earlier detection of melanoma lesions by immunoscintigraphy is still lacking. Anti-melanoma antibodies labeled with alpha- and beta-emitting isotopes are potential therapeutic agents, but so far there is little clinical experience with radioimmunotherapy of metastatic melanoma.
Eye Neoplasms↗
Photodynamic therapy in lung cancer. A review.
PDT utilizes photosensitizing agents that are selectively retained by tumors. These agents have high resulting tumor:tissue concentrations but are inactive by themselves. When activated by light, they generate free radicals, resulting in membrane injury, vascular injury, and immune-mediated injury with relatively selective cytotoxicity to tumor cells. Clinically, PDT can be used to treat CIS as well as more advanced lung cancers with endobronchial obstruction. PDT should be viewed as one tool of many that can be used to deal with airway problems in patients with lung cancer and it will often need to be used in conjunction with other techniques, such as airway stenting, Nd-YAG, or cryotherapy. For PDT to be effective, it must be integrated into a multimodality approach, including chemotherapy and radiation therapy.
Humans↗
GH receptor antagonist: mechanism of action and clinical utility.
This review focuses on the development of GH receptor antagonist as a novel agent for treatment of acromegaly, its mechanism of action and potential areas of use. A brief overview of acromegaly, its diagnosis and existing medical, surgical and radiotherapy options of treatment is necessary to justify the addition of yet another therapeutic modality to the already vast therapeutic armamentarium.
Acromegaly↗
The posteromedial portal in knee arthroscopy: an analysis of diagnostic and surgical utility.
We reviewed 400 consecutive knee arthroscopy cases in a predominantly sports medicine practice to determine (1) the frequency of posteromedial portal usage under a prospectively established set of indications, and (2) the impact of posteromedial portal access on patient diagnosis and management. Diagnostic posteromedial portals were used in 22% of anterior cruciate ligament (ACL)-deficient knees, and in 11% of stable knees with nonpatellar (usually meniscal) lesions. When used, posteromedial portal visualization showed treatable lesions 64% of the time, the majority of which were repairable peripheral meniscus tears. In 63% of these cases, no definite lesion had been identified by initial routine anterior portal viewing and probing. Of the 22 patients with posteromedial meniscus tears that were discovered only via posteromedial portal access, 9 had recently undergone anterior portal arthroscopy by other surgeons, during which none of these tears were detected. Posteromedial surgical portals (19 cases) were most useful for synovectomy, posterior cruciate stump resection before arthroscopic reconstruction, and posterior horn medial meniscectomy in exceptionally tight knees. Posteromedial portal access is often useful diagnostically in cases where (1) posteromedial meniscal lesions are frequent (i.e., ACL-deficient knees) and/or suspected on the basis of preoperative symptoms or imaging studies, and (2) full, direct visualization of the entire superior meniscosynovial junction is not possible via standard anterior portals. The option of a surgical posteromedial portal should be entertained whenever frontal approaches for posteromedial instrument work prove inefficient or unsuccessful.
Anterior Cruciate Ligament↗
Fiber-reinforced framework and Ceromer restorations: a technical review.
The utilization of synthetic resins and ceramics in combination with metal frameworks continues to be the mainstay of crown and bridge prosthetics. Although most of these systems have resulted in years of clinical success, each material when used in combination has inherent properties that induce stresses to the system. The combination of ceramic technology and polymer research, in addition to fiber integration, has resulted in the development and introduction of a new category of crown and bridge materials--a ceromer and fiber-reinforced restorative system. This article examines the history of polymer and ceramic technology, and reports the clinical and research data currently available on one indirect ceromer system (Targis System, Ivoclar Williams, Amherst, NY).
Ceramics↗
Estimation of an optimal radiotherapy utilization rate for breast carcinoma: a review of the evidence.
BACKGROUND: Radiotherapy utilization rates for breast carcinoma vary widely, both within and between countries. Current estimates of the proportion of patients with carcinoma who optimally should receive radiotherapy are based either on expert opinion or on the measurement of actual utilization rates, and not on the best scientific evidence. METHODS: To develop an evidence-based benchmark for radiotherapy utilization in patients with breast carcinoma, the authors undertook a systematic review of treatment guidelines on the use of radiotherapy for breast carcinoma. A decision tree was constructed, and the proportions of patients with clinical features that lead to a decision for radiotherapy were obtained from epidemiological data. This ideal utilization rate was compared with the utilization rates of radiotherapy over the last decade for breast carcinoma in Australia and internationally. RESULTS: The proportion of patients with breast carcinoma in whom radiotherapy would be recommended according to the best available evidence was calculated at 83% (95% confidence interval, 82-85%) of all patients with breast carcinoma. A review of actual radiotherapy utilization rates for breast carcinoma revealed that, in clinical practice, actual utilization rates varied between 24% and 71%. CONCLUSIONS: A substantial difference was found between the recommended optimal utilization of radiotherapy based on evidence and the actual rates reported in clinical practice. The reasons for these differences need to be examined, and a plan for addressing the suboptimal use of radiotherapy needs to be implemented. Cancer 2003.
Breast Neoplasms↗