[Medical audit in the United States: a model for medical review in out country? Report of a study trip].
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Automation↗
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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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[Profile of biostatistics utilization in three medical reviews. Implications for medical education].
OBJECTIVE: To identify the most commonly used biostatistical concepts and tests in three journals read by family physicians. DESIGN: Descriptive study of the biostatistical content of 12 issues of the Canadian Medical Association Journal (CMAJ), Canadian Family Physician (CFP), and the New England Journal of Medicine (NEJM). MAIN OUTCOME MEASURES: Frequency of citations of concepts and tests, and Spearman's correlation coefficients comparing the biostatistical profiles of the three journals. RESULTS: Biostatistical content of NEJM was diverse (on average, 39 concepts and 21 tests per issue). In CFP, we found 10 concepts and four tests per issue. In CMAJ, there were, on average, nine concepts and five tests per issue. CONCLUSIONS: The journals' profiles (order of importance of concepts and tests) were fairly similar.
Family Practice↗
Reorganizing a department of medicine.
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Education, Medical↗
How stereotactic core-needle biopsy affected breast fine-needle aspiration utilization: an 11-year institutional review.
To determine the effect of stereotactic core-needle biopsy (SCNB) on the utilization of breast fine-needle aspirate (FNA) biopsy, we retrospectively reviewed 1,568 cases of breast FNAs that were obtained from 1,188 patients between the years 1990 and 2000. There were 378 positive and atypical cases and 497 negative and unsatisfactory cases in the pre-SCNB group (between 1990 and 1996; 7 years); and 225 positive and atypical cases and 468 negative and unsatisfactory cases in the post-SCNB group (between 1997 and 2000; 4 years). The average number of cases per year in the pre- and post-SCNB groups was 125 and 173, respectively. While the average positive/atypical cases per year in both groups remained relatively constant, the average negative/unsatisfactory cases per year were significantly increased in the post-SCNB group (117 in the post-SCNB vs. 71 in the pre-SCNB). The increase in this group was due to a true increase in the negative diagnoses, since unsatisfactory rate decreased in the post-SCNB group (12.6% in the post-SCNB vs. 9.3% in the pre-SCNB). The sensitivity, specificity, positive predictive value, and negative predictive value were 90%, 79%, 92%, and 82% in the pre-SCNB group and 93%, 86%, 91%, and 90% for the post-SCNB group, respectively. In conclusion, the implementation of SCNB did not result in a decrease in the total number of breast FNAs; however, the distribution of cases changed. FNA is increasingly used to complete the triple test in clinically and radiographically negative cases.
Biopsy, Fine-Needle↗
Pharmacist paradigm shift--drug review to management.
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Drug Utilization Review↗
St. Louis businesses start review program.
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Health Planning Organizations↗
Searching for the bottom line via review.
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Length of Stay↗
Medicare program; acquisition, protection, and disclosure of utilization and quality control peer review organization (PRO) information--HCFA. Final rule.
These regulations govern the acquisition, protection, and disclosure of information obtained or generated by Utilization and Quality Control Peer Review Organization (PROs). The Peer Review Improvement Act of 1982 authorizes PROs to acquire information necessary to fulfill their duties and functions, places limits on disclosure of PRO information, and establishes penalties for unauthorized disclosure. These regulations implement the PROs' statutory right of access to necessary information and set forth their responsibilities to assure that information once acquired is adequately safeguarded and disclosed only for proper purposes.
Centers for Medicare and Medicaid Services, U.S.↗
Medicare program; acquisition, protection and disclosure of utilization and quality control peer review organization (PRO) information--HCFA. Proposed rule.
This proposal would govern the acquisition, protection and disclosure of information obtained or generated by Utilization and Quality Control Peer Review Organizations (PROs). The Peer Review Improvement Act of 1982 authorizes PROs to acquire information necessary to fulfill their duties and functions, places limits on the disclosure of PRO information, and establishes penalties for unauthorized disclosure. These regulations would implement the PROs' statutory right of access to necessary information and set forth their responsibilities to assure that information once acquired is adequately safeguarded, and used only for proper purposes.
Centers for Medicare and Medicaid Services, U.S.↗
Medicare program; utilization and quality control peer review organizations; imposition of sanctions on health care practitioners and providers of health care services--HCFA. Proposed rule.
This proposal would implement the portion of the Peer Review Improvement Act of 1982 that imposes certain obligations on health care practitioners and other persons who provide health care services to Medicare beneficiaries. The proposal would also establish sanctions that the Secretary may impose for violations of the obligations. The proposal would also impose certain responsibilities on utilization and quality control peer review organizations and provides that an exclusion sanction recommended to the Secretary by utilization and quality control peer review organizations would automatically become effective if the Secretary fails to act within a 120-day review period. These regulations are intended to assure that the public receives medically necessary, quality health services.
Centers for Medicare and Medicaid Services, U.S.↗
Utility of a software assistant in critical care case review.
A computer program (the Audit Assistant) was developed to help physicians review the care of critically ill emergency department (ED) patients. The program is an example of a new class of decision aids that serves to remind physicians to consider possibilities, not an artificial intelligence program that actually attempts to simulate clinical reasoning. The goal of such programs is to enable physicians to reduce errors--in this case to enable reviewers to notice more of the errors in care in the cases they are reviewing. The objective of this study was to demonstrate on a small set of complex cases that the tested computer program enables the physician to perform a better quality review. The issue of what constitutes improved case review is addressed. In the first part of the study, reviewers reviewed two mock charts without using the Audit Assistant and then immediately reviewed the charts again with the assistance of the program. The reviews were compared. In the second part of the study, a second reviewer also compared the utility of the review of the first reviewer alone and the Audit Assistant output as an aid to review, using an additional mock chart. Six emergency physicians participated; each was a quality assurance director for the ED of one Cleveland area hospital. For the physicians reviewing without the Audit Assistant, 41% of critical actions were listed by three or four reviewers. For those using the Audit Assistant, 83% of critical actions were listed by three or four reviewers. All reviewers preferred the Audit Assistant-suggested list to the critical action list generated by a previous reviewer not using the Audit Assistant (P < .02). Use of the Audit Assistant improved the completeness and the consistency of physician review of mock charts of critically ill ED patients in a small series of cases. The critical actions added for review were important, as demonstrated by the preferential addition of critical actions chosen by other reviewers who were not using the computer program.
Critical Care↗
Construction and characteristics of the RxRisk-V: a VA-adapted pharmacy-based case-mix instrument.
BACKGROUND: Assessment of disease burden is the key to many aspects of health care management. Patient diagnoses are commonly used for case-mix assessment. However, issues pertaining to diagnostic data availability and reliability make pharmacy-based strategies attractive. Our goal was to provide a reliable and valid pharmacy-based case-mix classification system for chronic diseases found in the Veterans Health Administration (VHA) population. OBJECTIVE: To detail the development and category definitions of a VA-adapted version of the RxRisk (formerly the Chronic Disease Score); to describe category prevalence and reliability; to check category criterion validity against ICD-9 diagnoses; and to assess category-specific regression coefficients in concurrent and prospective cost models. RESEARCH DESIGN: Clinical and pharmacological review followed by cohort analysis of diagnostic, pharmacy, and utilization databases. SUBJECTS: 126,075 veteran users of VHA services in Washington, Oregon, Idaho, and Alaska. METHODS: We used Kappa statistics to evaluate RxRisk category reliability and criterion validity, and multivariate regression to estimate concurrent and prospective cost models. RESULTS: The RxRisk-V classified 70.5% of the VHA Northwest Network 1998 users into an average of 2.61 categories. Of the 45 classes, 33 classes had good-excellent 1-year reliability and 25 classes had good-excellent criterion validity against ICD-9 diagnoses. The RxRisk-V accounts for a distinct proportion of the variance in concurrent (R2 = 0.18) and prospective cost (R2 = 0.10) models. CONCLUSIONS: The RxRisk-V provides a reliable and valid method for administrators to describe and understand better chronic disease burden of their treated populations. Tailoring to the VHA permits assessment of disease burden specific to this population.
Adolescent↗
The utility of clinical neurophysiological and quantitative sensory testing for trigeminal neuropathy.
This article reviews the utility of neurophysiological recordings and quantitative sensory testing (QST) in providing sensitive, quantitative, and objective tests for the diagnosis and localization of damage to the trigeminal nerve. Electromyography and recordings of the masseter reflex and compound muscle action potential evoked by transcranial magnetic stimulation or direct electrical stimulation of the masseteric nerve can be of value in evaluating the function of a motor neurons supplying the muscles of mastication. Orthodromic recording of the sensory action potential and trigeminal somatosensory-evoked potential recording with the near-nerve stimulation technique are sensitive tools for the investigation of trigeminal sensory Abeta afferents, whereas recordings of polysynaptic trigeminal brainstem reflexes and tactile QST are less sensitive. At late stages of recovery, the blink reflex and masseter inhibitory reflex are often normal, but at earlier stages, the blink reflex recording has good prognostic value, and the presence of a reflex response may confirm continuity of the nerve trunk after partial laceration. Trigeminal small-fiber function (Adelta and C) can be studied with thermal QST of the cool, warm, heat pain, and cold pain detection thresholds or with laser-evoked potential recording. Thermal QST may remain abnormal years after axonal damage and aids in the diagnosis of late sequelae of trigeminal nerve injury. In a study of the diagnostic value of neurography, blink reflex and thermal QST, and various commonly used clinical sensory tests, neurophysiologic tests and thermal QST had better sensitivity (50% to 88% vs 40% to 59%) and negative predictive values (78% to 100% vs 70% to 74%) compared to clinical examination, whereas the specificity (55% to 100%) and positive predictive values (48% to 73%) were similar. At 1 year after trigeminal nerve injury, the risk of a false negative finding with clinical sensory testing was 94%, whereas the combination of nerve conduction recordings and thermal QST increased the diagnostic yield to 100% in patients with long-standing postsurgical sensory alteration. In conclusion, clinical neurophysiological recordings and QST improve the diagnostic accuracy for trigeminal neuropathy.
Cranial Nerve Injuries↗
The impact of the accessibility of cranial CT scans on patient evaluation and management decisions.
OBJECTIVES: Cranial CT scans are amongst the most frequently performed radiological investigations performed in most developed countries. However, these tests are relatively expensive and economic realities should compel physicians to re-evaluate the utilization of this technology. The aim of this study was to review the utilization pattern and effect on management decisions of cranial CT scanning. DESIGN: Retrospective chart review. SETTING: University-affiliated community teaching hospital. SUBJECTS: The clinical data on 451 consecutive patients undergoing cranial CT scanning in our radiology department were reviewed. Eighty-five patients were referred from outside the hospital and were subsequently excluded from further analysis. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The following data was abstracted from each patient's chart: the presenting clinical syndrome, the physician ordering the scan, details of the neurological examination performed prior to scanning, the CT scan findings and the impact the CT scan findings had on management decisions. RESULTS: The largest percentage of patients were referred from the emergency department (61%). Chronic intracranial lesions were present in 77 (21%) patients. New pathological findings were found in 91 (25%) patients. The commonest new lesions were ischaemic infarcts (43%), followed by intracerebral haemorrhage (13%) and space occupying lesions (11%). Ninety-seven per cent of patients presenting with new focal neurological signs had new findings on the CT scan, compared to 28% of patients with severe headache and 27% with a history of loss of consciousness. Head trauma was the presenting problem in 139 patients. New pathological findings were diagnosed in 24 of these patients. Fifty-four patients had no signs or symptoms referable to the central nervous system. None of these patients had new findings on CT scan. In the vast majority of patients the neurological examination performed prior to CT scanning was incomplete. CT scanning was considered to have altered the management or provided a new diagnosis in 162 (44%) patients; of these patients 61 (67%) were in the group with new findings on CT scanning and 101 (37%) in the group with no new findings. CONCLUSION: In this study cranial CT scanning affected clinical management decisions in less than half of the patients. Furthermore, a careful history and neurological examination was performed in the minority of patients undergoing CT scanning. It would therefore appear that the easy accessability of CT scans largely determines the utilization of this diagnostic tool.
Brain Diseases↗
Barriers to appropriate utilization of an acute facility.
Professional Standards Review Organizations (PSROs) have been mandated to assure appropriate utilization of health resources. In order to meet this objective, PSROs must be able to determine when and why health resources are misutilized so that corrective action may be taken. This paper describes a study designed to identify and measure the significance of factors causing the misutilization of beds at one hospital. Using explicit Medicare levels of care criteria, a utilization review nurse coordinator determined the appropriate location (hospital, skilled nursing facility, home health care, home with outpatient or no care) or a sample of hospital patients. When a patient was judged inappropriately located on a particular day the nurse coordinator identified the barrier(s) to appropriate utilization, i.e., the reason(s) the patient remained in the hospital. Approximately 10 per cent of the 1,902 patient days were judged inappropriate at a hospital level of care. The most significant barriers to appropriate utilization were 1) the unavailability of skilled nursing facilities with the necessary amount of nursing services, and 2) the attending physician's conservative medical management of the patient. The implications for reduction of hospital misutilization are discussed.
Classification↗
Antibiotic monitoring as a surveillance tool for nosocomial infections.
A programme for surveillance of nosocomial infections utilizing antibiotic review was developed and carried out at Saint Barnabas Medical Center, Livingston, New Jersey, USA. Over a 6-month period 1083 charts were reviewed on the surgical units by an infection control practitioner utilizing two methods of surveillance for nosocomial infections. The first method utilized positive laboratory cultures, admission data and head nurse interviews. The second method used a prevalence study of all surgical patients on antibiotic therapy and all positive culture reports. A comparison of both methods revealed that all nosocomial infections were realized using antibiotic review. It was also noted that 16.2 per cent of nosocomial infections were missed by not using antibiotic review as a surveillance tool. We also noted that the overall percentage of patients with nosocomial infections not cultured was 10.5 per cent. Our conclusions were that antibiotic review is a useful instrument that can successfully be incorporated into any currently existing infection control surveillance programme.
Anti-Bacterial Agents↗