Summary: Review of the medical necessity of hospital or other health facility admissions, upon or within a short time following an admission, and periodic review of services provided during the course of treatment.
- Clinical and fiscal outcomes of utilization reviewMary Ellen Murray
School of Nursing, University of Wisconsin Madison, K6 340 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
Outcomes Manag 8:19-25; quiz 26-7. 2004..Payers then make a decision whether to certify the care for reimbursement. This study provides data to indicate that denials of certification have little impact on clinical and fiscal outcomes of patient care...
- Managed care organizations' use of treatment management strategies for outpatient mental health careElizabeth Levy Merrick
Schneider Center for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454 9110, USA
Adm Policy Ment Health 33:104-14. 2006..and treatment management techniques (prior authorization, standards for time to initial appointment, concurrent review, standards for follow-up after discharge, case management, practice guidelines)...
- Expert consensus-based medication-use evaluation criteria for atypical antipsychotic drugsRaymond C Love
Department of Pharmacy, Practice and Science, University of Maryland School of Pharmacy, Baltimore, USA
Am J Health Syst Pharm 60:2455-70. 2003..Combination antipsychotic treatment always warranted at least concurrent review. Continued concerns about the use of ziprasidone and its cardiac effects were apparent...
- Outcomes of community-acquired, methicillin-resistant Staphylococcus aureus, soft tissue infections treated with antibiotics other than vancomycinEdward V Barnes
Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
Mil Med 171:504-7. 2006..from which cMRSA was isolated and who had never received vancomycin were studied through retrospective and concurrent review. Primary outcome measures were improvement or resolution of infection 5 and 14 days after initiation of ..
- Estimation of risks associated with paediatric cochlear implantationJ Cyne Johnston
University of Ottawa, Canada
Cochlear Implants Int 11:146-69. 2010..This hospital-based retrospective chart review and review of the literature provide readers with an estimation of the risks to aid in evidence-based decision-making surrounding paediatric cochlear implantation...
- Cervical pregnancy treated with transvaginal ultrasound-guided intra-amniotic instillation of methotrexateD Hassiakos
2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Alexandras Avenue 108, 11522 Athens, Greece
Arch Gynecol Obstet 271:69-72. 2005Aim of the study was to investigate the efficacy of single transvaginal ultrasound-guided intraamniotic installation of methotrexate in the management of cervical pregnancy with concurrent review of the literature.
- The 10-minute oral presentation: what should I focus on?Carlos A Estrada
Division of General Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294 3407, USA
Am J Med Sci 329:306-9. 2005..We sought to empirically identify what features of a scientific oral presentation experienced reviewers focus on when asked to identify the best features and areas to improve...
- Improving patient outcomes in an ambulatory infusion setting: decreasing infusion reactions of patients receiving paclitaxel and carboplatinRoseann Huddleston
York Cancer Center WellSpan Health, York, PA, USA
J Infus Nurs 28:170-2. 2005..Staff members examined the performance improvement data, conducted a retrospective study, and collaborated with the primary physician providers to develop rechallenge protocols for patients receiving paclitaxel and carboplatin regimens...
- Factors causing patients to delay seeking treatment after suffering a strokeMolly John
Dept of Internal Medicine, West Virginia University School of Medicine, Charleston Division, USA
W V Med J 101:12-5. 2005..We recommend educating the community about the symptoms of stroke and focusing on the fact that stroke is a medical emergency and calling 911 is necessary...
- A methodology for timing reviews of inpatient hospital stayAndrew C Page
Clinical Psychology Unit, School of Psychology, University of Western Australia
Aust N Z J Psychiatry 39:198-201. 2005..This paper aims to describe a methodology to inform decisions about the optimal time to schedule reviews of a patient's hospital stay and to provide an example of its implementation...
- The relentless pursuit of perfection in a machine bureaucracy: its impact on the practice of oral and maxillofacial surgeryLeon A Assael
J Oral Maxillofac Surg 62:1329-30. 2004
- A proactive (and financially beneficial!) approach to utilization managementJulie A Micheletti
Clinical Product Strategies, HSS, Inc, Germantown, MD, USA
Healthc Financ Manage 58:38-42. 2004..If hospitals are to minimize denials and reduce costs amid these pressures, they will need to adopt several key strategies, including effectively employing use of a dedicated physician adviser...
- Spironolactone use in patients with heart failureJ M Trujillo
Northeastern University School of Pharmacy, Northeastern University, Boston, MA 02115 5000, USA
J Clin Pharm Ther 29:165-70. 2004..The addition of spironolactone, an aldosterone antagonist, to standard therapy can reduce the risk of both morbidity and mortality in patients with severe heart failure...
- Will Medicare pay for concurrent hospital-owned outpatient wound department visits and procedures?Kathleen D Schaum
Kathleen D Schaum and Associates Inc, 6491 Rock Creek Drive, Lake Worth, FL 33467, USA
Adv Skin Wound Care 17:91-2. 2004
- The Mentor Model: care management in the 21st CenturyRichard B Birrer
St Joseph s Regional Medical Center, Paterson, NJ, USA
Physician Exec 30:20-4. 2004
- Clinical Risk Groups (CRGs): a classification system for risk-adjusted capitation-based payment and health care managementJohn S Hughes
Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
Med Care 42:81-90. 2004....
- Improving physician documentation through a clinical documentation management programTamara A Hicks
North Carolina Baptist Hospital, Medical Center Boulevard, Winston Salem, NC 27157, USA
Nurs Adm Q 27:285-9. 2003....
- Pneumococcal vaccination process improvement in an acute care settingAbigail M Yancey
Department of Pharmacy Practice, St Louis College of Pharmacy, St Louis, Missouri 63110 1088, USA
Qual Saf Health Care 19:e61. 2010..SSM St Mary's Health Center chartered a multidisciplinary team to address a disappointing pneumococcal vaccination rate of 34.7% in the first quarter of 2005...
- [Inappropriate hospitalization use in general surgery wards. Magnitude, associated factors and causes]Pedro Antón
Fundación Instituto de Investigación en Servicios de Salud, Valencia, Spain
Cir Esp 78:183-91. 2005..To determine the proportion of inappropriate days of hospitalization in the general surgery wards of three university hospitals, its causes, and associated factors...
- Effect of drug utilization reviews on the quality of in-hospital prescribing: a quasi-experimental studyJean Pierre Grégoire
Population Health Research Unit, Centre Hospitalier Affilie Universitaire De Quebec, 1050 Chemin Ste Foy, Quebec, QC, G1S 4L8, Canada
BMC Health Serv Res 6:33. 2006..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...
- Rehospitalization rate after continued electroconvulsive therapy--a retrospective chart review of patients with severe depressionAxel Nordenskjöld
Department of Psychiatry, Orebro County Council, Orebro, Sweden
Nord J Psychiatry 65:26-31. 2011..Today ECT is usually discontinued when the patient's depressive symptoms abate, although relapse is common. Some studies suggest that continuation ECT (cECT) may prevent relapse of depression, but there are few studies available...
- Nationwide implementation of antibiotic management teams in Belgian hospitals: a self-reporting surveyEvelyne Van Gastel
Belgian Antibiotic Policy Coordination Committee BAPCOC, Federal Public Service Health, Food Chain Safety and Environment, Victor Horta plein 40 10, 1060 Brussels, Belgium
J Antimicrob Chemother 65:576-80. 2010..We performed a national, self-reporting survey to assess the level of AMT activities in 2007...
- Managing medical necessity and notification denialsOlakunle Olaniyan
Case Management Covenants LLC, Columbia, MD, USA
Healthc Financ Manage 63:62-7. 2009Hospitals should take a strategic approach to denials management. Some key areas to monitor are: Prior authorization/notification. Concurrent review. The appeals process.
- A strategic approach to managed care contractingAnn Bittinger
Law office, 13500 Sutton Park Drive South, Jacksonville, FL, USA
J Clin Rheumatol 13:346-9. 2007
- Blood conservation in the critically illJennifer Thomas
Intensive Care Unit, St Agnes Hospital Pharmacy, Baltimore, MD 21229, USA
Am J Health Syst Pharm 64:S11-8. 2007....
- Best practices for improving revenue capture through documentationErin Richter
The Advisory Board Company, Washington, DC, USA
Healthc Financ Manage 61:44-7. 2007....
- Substitution of hospital staff in concurrent utilization reviewJulie Darmody
Clinical Science Center, School of Nursing, University of Wisconsin Madison, Madison, WI 53792, USA
J Nurs Care Qual 22:239-46. 2007..The implications are that hospitals could substitute assistive staff in place of registered nurses to complete the CUR function, potentially increasing the availability of professional nurses...
- Who needs a palliative care consult?: the Hamilton Chart Audit toolMarissa Slaven
Department of Palliative Care, McMaster University, Hamilton, Ontario, Canada
J Palliat Med 10:304-7. 2007..We report on development of the tool and use of the tool for a retrospective audit of 222 patients who died at our institution...
- Is managed care closing substance abuse treatment units?Rebecca Wells
Department of Health Policy and Administration, School of Public Health, University of North Carolina, Chapel Hill 27599 7411, USA
Manag Care Interface 20:28-32. 2007..care, percentage of clients for whom prior authorization was required, and percentage of clients for whom concurrent review was required...
- Positioning your facility for severity adjusted codingPaul Whitaker
LexiCode Corporation, USA
J AHIMA 78:82-4. 2007
- Managing the interface between acute care and rehabilitation - can utilisation review assist?Christopher J Poulos
Department of Rehabilitation, South Eastern Sydney and Illawarra Area Health Service, Port Kembla Hospital, Cowper St, Wollongong, NSW
Aust Health Rev 31:S129-40. 2007..Consecutive acute care patients with a diagnosis of stroke, hip fracture or amputation, and patients referred for rehabilitation assessment, were followed using the InterQual Criteria...
- [Appropriateness of hospital admissions to a pulmonology department]Francisco Campos Rodriguez
Servicio de Neumologia, Hospital Universitario de Valme, Sevilla, Espana
Arch Bronconeumol 42:440-5. 2006..To analyze the rate of inappropriate admissions to a pulmonology department over the period of a year and to establish the reasons for such admission and predictors...
- [Appropriateness of hospitalization in a ward of internal medicine--using the Appropriateness Evaluation Protocol]Nuno B Vieira
Serviço de Medicina Sector1, Centro Hospitalar do Barlavento Algarvio, Portimao
Acta Med Port 19:67-70. 2006..The Appropriateness Evaluation Protocol (AEP) is an instrument to study the appropriate use of hospital beds based in objective criteria that classify a hospital admission as appropriate or inappropriate...
- Active surveillance using electronic triggers to detect adverse events in hospitalized patientsM K Szekendi
Division of Operations and Quality, Patient Safety, Northwestern Memorial Hospital, Chicago, IL 60611, USA
Qual Saf Health Care 15:184-90. 2006..We hypothesized that it would be possible to design a method to conduct real time active surveillance and conducted a pilot study to identify adverse events and medical errors...
- The impact of verbal communication on physician prescribing patterns in hospitalized patients with diabetesKay Martin
American Healthways, Prince George s Hospital Center, Cheverly, Maryland, USA
Diabetes Educ 29:827-36. 2003....
- Detection of postoperative surgical-site infections: comparison of health plan-based surveillance with hospital-based programsKenneth E Sands
Centers for Disease Control and Prevention, Eastern Massachusetts Prevention Epicenter, Boston, Massachusetts, USA
Infect Control Hosp Epidemiol 24:741-3. 2003..We compared these two methods for identifying SSIs following coronary artery bypass graft (CABG) procedures...
- Prenatal HIV counseling and testing in California: women's experiences and providers' practicesJuan D Ruiz
California Department of Health Services, Office of AIDS, Sacramento 94234 7320, USA
AIDS Educ Prev 14:190-5. 2002..Women may have underreported prenatal C&VT because providers spend insufficient time discussing related issues or because C&VT information is not presented in a way that is relevant to all patients...
- To stay or not to stay. The assessment of appropriate hospital stay: a Dutch reportLambert J G G Panis
Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, The Netherlands
Int J Qual Health Care 14:55-67. 2002....
- Use of measurement audit in outcomes managementJohn S Lyons
Mental Health Services and Policy Program, Northwestern University Medical School, 339 East Chicago Avenue, Room 717, Chicago, IL 60611, USA
J Behav Health Serv Res 29:75-80. 2002..Findings suggest generally good reliability, 0.72 overall, with some variation by provider and type of information...
- [Cause of non-pertinent hospital stays: interobserver concordance using the French version of the Appropriateness Evaluation Protocol]I Lombard
, Cedex, France
Rev Epidemiol Sante Publique 49:367-75. 2001..It might help to detect dysfunctions within or outside the hospital and thus be used for evaluation or planning of health care...
- Implementation of standing field treatment protocols in an urban EMS systemM Eckstein
Department of Emergency Medicine, University of Southern California School of Medicine, Los Angeles, CA 90033, USA
Am J Emerg Med 19:280-3. 2001..None of these instances resulted in adverse effects or complications. SFTPs were integrated into a large EMS system with few procedural errors or adverse outcomes...
- Inappropriate use of an accident and emergency department: magnitude, associated factors, and reasons--an approach with explicit criteriaT Sempere-Selva
Servicio de Urgencias, Hospital General Universitario, Elche, Spain
Ann Emerg Med 37:568-79. 2001..METHODS: This concurrent review of a random sample of 2,980 adult medical patients' visits to the A&ED of the hospital of Elche uses the ..
- Underutilization of acute care settings in a tertiary care hospitalB Trerise
Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
Int J Qual Health Care 13:27-32. 2001..To estimate underutilization of acute care settings in a tertiary care hospital...
- Using a continuous time hidden Markov process, with covariates, to model bed occupancy of people aged over 65 yearsG Christodoulou
Academic Department of Geriatric Medicine, St. George's Hospital Medical School, University of Bath, UK
Health Care Manag Sci 4:21-4. 2001..The addition of covariates provides us with evidence of a difference in length of stay between men and women. However, even significant alterations to the mean age of patients in the model does not effect the length of stay...
- [Corroboration of concurrent assessment of inappropriate hospitalization with retrospective evaluation based on patient records]S Schneeweiss
Bayerischer Forschungsverbund Public Health
Gesundheitswesen 62:207-10. 2000..The objective was to assess the agreement of concurrent and retrospective assessment of inappropriate hospital use...
- Utilization management in a large managed behavioral health organizationA Koike
Department of Psychiatry, University of California, Davis, USA
Psychiatr Serv 51:621-6. 2000..The utilization management process of a managed behavioral health organization was examined to determine the frequency and types of reviews and the extent to which rationing of service was achieved through the denial of services...
- Patients' and providers' perceptions of outpatient treatment termination in a managed behavioral health organizationB Cuffel
United Behavioral Health, 425 Market Street, 27th Floor, San Francisco, CA 94105, USA
Psychiatr Serv 51:469-73. 2000..complaint about managed care is that treatment decisions of patients and providers are frequently altered by concurrent review of ongoing outpatient treatment...
- Effects of utilization management on patterns of hospital care among privately insured adult patientsT M Wickizer
Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle 98195 7660, USA
Med Care 36:1545-54. 1998..This study examined the effects of utilization management review activities on patterns of hospital care among a sample of adult patients insured through a managed fee-for-service plan...
- Relationship of physician ratings of severity of illness and difficulty of clinical management to length of stayC Kelleher
Office of Health Services Research, Baltimore U S Public Health Service Hospital, MD
Health Serv Res 27:841-55. 1993....
- Using treatment plans for quality assurance monitoring in a residential centerS B Price
Hillside Children s Center, Rochester, New York
QRB Qual Rev Bull 14:266-74. 1988..QA staff use checklists to review plans to assure that they are complete and technically correct and to evaluate the quality and appropriateness of care as revealed in the treatment strategy...
- Use of generic quality improvement chart review to recognize nosocomial infectionM Buchanan Chell
University of Alberta Hospitals, Edmonton, Canada
Am J Infect Control 20:310-4. 1992..CONCLUSION: We conclude that this chart surveillance has only moderate sensitivity and specificity compared with our infection control surveillance methods. Improvements were not demonstrated with experience...
- Psychometric properties and utility of the problem severity summary for adults with serious mental illnessDebra S Srebnik
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, 98104, USA
Psychiatr Serv 53:1010-7. 2002..The authors studied the psychometric properties and utility of the Problem Severity Summary (PSS), a 13-item instrument that assesses symptom severity and functioning among adults with severe and persistent mental illness...
- A quality improvement project for better glycemic control in hospitalized patients with diabetesJ A Gilman
Diabetes Care Services, St Patrick Hospital and Health Sciences Center, 500 W Broadway, Missoula, MT 59802, USA
Diabetes Educ 27:541-6. 2001..The objective was to improve the timing of premeal insulin to allow a half hour lag time for regular insulin...
- How to minimize inappropriate utilization of Accident and Emergency Departments: improve the validity of classifying the general practice cases amongst the A&E attendeesAlbert Lee
Department of Community and Family Medicine, The Chinese University of Hong Kong, School of Health, Prince of Wales Hospital, N T, Shatin, Hong Kong
Health Policy 66:159-68. 2003..If implemented, a significant impact on hospital costs could be realized...
- An exploratory cost analysis of performing hospital-based concurrent utilization reviewMary Ellen Murray
School of Nursing, University of Wisconsin Madison, K6 340 Clinical Science Center, 600 Highland Ave, Madison, WI 53792 2455, USA
Am J Manag Care 9:512-8. 2003..To determine the costs associated with conducting concurrent utilization review, a utilization management strategy widely used by the managed care industry...
- Denials of reimbursement for hospital careMary Ellen Murray
School of Nursing, University of Wisconsin, Madison, USA
Manag Care Interface 16:22-7. 2003....
- Validation of the Hendrich II Fall Risk Model: a large concurrent case/control study of hospitalized patientsAnn L Hendrich
Methodist Hospital, Indianapolis, Indiana, USA
Appl Nurs Res 16:9-21. 2003..The result of the study is an easy to use validated Hendrich Fall Risk Model with eight assessment parameters for high-risk fall identification tested in acute care environments...
- Professional practice solutions...record completion policiesMichelle Dougherty
J AHIMA 74:62, 64. 2003
- Web-based clinical decision support system for triage of vestibular patientsWilliam C Kinney
Department of Surgery Otolaryngology, University of Missouri Columbia, 65212, USA
Otolaryngol Head Neck Surg 128:48-53. 2003..We sought to use a clinical decision support system (CDSS) to save costs and to improve scheduling of vestibular patients in an otolaryngology clinic...
- Metric properties of the appropriateness evaluation protocol and predictors of inappropriate hospital use in Germany: an approach using longitudinal patient dataOliver Sangha
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
Int J Qual Health Care 14:483-92. 2002..Attempts at quality improvement need to relate costs to outcomes. Until now, there has been no standardized methodology to evaluate the appropriateness of hospital care...
- Profiling resource use: do different outcomes affect assessments of provider efficiency?Amy K Rosen
Center for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Medical Center, Bedford, MA 01730, USA
Am J Manag Care 8:1105-15. 2002..To examine whether 2 outcome measures result in different assessments of efficiency across 22 service networks within the Department of Veterans Affairs (VA)...
- Reducing failed extubations in the intensive care unitPeter J Pronovost
Departments of Anesthesiology Critical Care Medicine and Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Meyer 295, Baltimore, MD 21287 7294, USA
Jt Comm J Qual Improv 28:595-604. 2002..A study was designed in 1998 to identify risk factors for failed extubation and use a quality improvement model to reduce failed extubation rates in a surgical intensive care unit (SICU) in an academic hospital...
- A comparison of diagnosis capture from medical records, self-reports, and drug registrations: a study in individuals 80 years and olderSven E Nilsson
Institute of Gerontology, University College of Health Sciences, Jonkoping, Sweden
Aging Clin Exp Res 14:178-84. 2002..Reports of diseases and health problems vary as a function of the information source. In the present study we compared the capture of information on morbidity using medical records, self-reports, and drug registrations...
- Déjà vu. When it comes to prospective payment, home health agencies can learn from the experiences of acute care hospitals with DRGsPatricia B Dray
3M Health Information Systems, Wallingford, CT, USA
Health Manag Technol 23:44-6, 50. 2002
- Diagnostic cost groups (DCGs) and concurrent utilization among patients with substance abuse disordersAmy K Rosen
Center for Health Quality, Outcomes and Economic Research, Bedford VAMC Edith Nourse Rogers Memorial Veterans Hospital, MA 01730, USA
Health Serv Res 37:1079-103. 2002..To assess the performance of Diagnostic Cost Groups (DCGs) in explaining variation in concurrent utilization for a defined subgroup, patients with substance abuse (SA) disorders, within the Department of Veterans Affairs (VA)...
- Methodology to improve data quality from chart review in the managed care settingLaura D Cassidy
Department of Biostatistics, University of Pittsburgh, Graduates School of Public Health, PA 15261, USA
Am J Manag Care 8:787-93. 2002....
- Back to the drawing board: new directions in health plans' care management strategiesSuzanne Felt-Lisk
Mathematica Policy Research, Inc, Washington, DC, USA
Health Aff (Millwood) 21:210-7. 2002..Still, disease management programs will need to greatly expand in scope and scale if plans are to succeed in addressing the complex health care needs of aging populations and those with chronic diseases...
- New methods for evaluating utilization management programsS M Payne
Health Services Department, Boston University School of Public Health, MA 02118 2394
QRB Qual Rev Bull 18:340-7. 1992..The "program component" method measures the separate effect of preadmission review, concurrent review, and discharge planning...
- Effects of health care cost-containment programs on patterns of care and readmissions among children and adolescentsT M Wickizer
Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle 98195 7660, USA
Am J Public Health 89:1353-8. 1999..This study examined the effects of a utilization management program on patterns of medical care among children and adolescents...
- A nurse practitioner intervention model to maximize efficient use of telemetry resourcesPeter A Gross
Department of Internal Medicine, Hackensack University Medical Center HUMC, Hackensack, New Jersey, USA
Jt Comm J Qual Improv 28:566-73. 2002..use entailed the use of an advanced practice nurse (APN; identical to a nurse practitioner) to provide concurrent review and intervention of floating telemetry, which is available for patients independently of the floor location ..
- Improving Long-Term Physical and Mental Health after Acute Lung InjuryPeter Pronovost; Fiscal Year: 2009....
- How child welfare inter-agency cooperation may reduce youth HIV risk behaviorsRebecca Wells; Fiscal Year: 2007..These findings will inform managers of related health and social services.yield actionable guidance to child welfare agency managers and policy makers in allocating scarce resources. ..
- How Child Welfare Agency Management Affects Children's OutcomesRebecca Wells; Fiscal Year: 2007..Subsequent research will examine how child welfare and mental health agencies collectively affect children. ..
- PARTICIPATION IN COMMUNITY-BASED COALITIONSRebecca Wells; Fiscal Year: 2005..This study will lay the groundwork for subsequent research establishing a mid-range theory of community-based health promotion coalition participation. ..
- Alcohol Use and Medical Care Quality among the ElderlyELIZABETH MERRICK; Fiscal Year: 2006..abstract_text> ..
- IMPACT OF MENTAL HEALTH ADVANCE DIRECTIVESDebra Srebnik; Fiscal Year: 2004..Multi- stakeholder focus groups will be conducted for Aim 2c. Electronic information systems will provide demographic, diagnostic, level-of-functioning, outpatient commitment status and service utilization data. ..
- Improving Long-Term Physical and Mental Health after Acute Lung InjuryPeter J Pronovost; Fiscal Year: 2010....