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Utilization Review and Management: A Brief Analysis of a Growth Industry

Published online by Cambridge University Press:  21 June 2016

William B. Credè  and
Walter J. Hierholzer Jr
William B. Credè
Affiliation:
Departments of Quality Assurance, Yale-New Haven Hospital, New Haven, Connecticut
Walter J. Hierholzer Jr*
Affiliation:
Hospital Epidemiology, Yale-New Haven Hospital, New Haven, Connecticut
*
Medical Director, Department of Hospital Epidemiology, Yale-New Haven Hospital, New Haven, CT 06504
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Extract

Inpatient hospital care consumes more than 30% of health insurance dollars regardless of the reimbursement mechanism, be it standarti fee-for-service, preferred provider organization (PPO), or health maintenance organization (HMO). It is understandable that reducing these costs has become the highest priority of health care purchasers, and that utilization review and management, the process of evaluating and attempting to reduce the cost of medical practice, has become a major growth industry with providers and purchasers of health care.

Type
Special Sections
Information
Infection Control & Hospital Epidemiology , Volume 10 , Issue 1 , January 1989 , pp. 33 - 36
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1989

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References

1.Payne, SMC: Identifying and managing inappropriate hospital utilization: A policy synthesis. Health Sev Res. 1987;22:709–769.Google Scholar
2.Wennberg, J, Gittelsohn, A: Small area variations in health care delivery. Science. 1973;182:1102–1108.CrossRefGoogle ScholarPubMed
3.Banta, HD, Kemp, KB (eds): The implications of cost-effectiveness analysis of medical technology. Background Paper #4. The Management oof Health Care Technology in in Countries. Washington, DC, Office of Technology Assessment, US Congress, 1980.Google Scholar
4.Chassin, MR, Kosecoff, J, Solomon, DH, et al: HOW coronary angiography is used, Clinical determinants of appropriateness. JAMA. 1987;258:2543–2547.Google Scholar
5.Wennbergl, F:The paradox of appropriate care. JAMA. 1987;258:2568–2569.CrossRefGoogle Scholar
6.Chassin, MR, Kosecoff, J, Park, RE, et al: Does inappropriate use explaiii geographic variations in the use of health care services? A study of three procedures. JAMA. 1987;258:2533–2537.Google Scholar
7.Sin, AL, Sonnenberg, FA, Manning, WG, et al: Inappropriate use of hospitals in a randomized trial of health insurance plans. N Engl J Med. 1986;315:1259–1266.Google Scholar
8.Kemper, KJ: Medically inappropriate use in a pediatric population. N Engl J Med. 1988;318:1033–1037.CrossRefGoogle Scholar
9.Manning, WG, Leibowitz, A, Goldberg, GA, et al: A controlled trial of the effect of a prepaid group practice on use of services. N Engl J Med. 1984;1505–1510.CrossRefGoogle ScholarPubMed
10.Restuccia, JD, Kreger, BE, Payne, SMC, et al: The appropriateness of hospital use in Massachusetts. Health Care Financing Rev. 1986;8:47–54.Google Scholar
11.Myers, LP, Schroeder, SA: Physician use of services fbr the hospitalized patient: A review with implications for cost-containment. Milbank Mem Fund. Q 1981;59:481–507.Google Scholar
12.Schroeder, SA. Myers, LP, McPhee, SJ, et al: The lailure of physician education as a cost containment strategy. Report of a prospective controlled trial at a university hospital. JAMA. 1984;252:225–230.Google Scholar
13.Wennberg, JE, Blowers, L, Parker, R, et al: Changes in tonsillectomy rate associated with feedback and review. Pediatrics. 1977;59:821–826.CrossRefGoogle ScholarPubMed
14.Martin, AR, Wolf, MA, Thibodeau, LA, et al: A trial of two strategies to modify the test ordering behavior of medical residents. N Engl J Med. 1980;303:1330–1336.Google Scholar
15.Feldstein, PJ, Wickizer, TM, Wheeler, JRC: Private cost containment the effects of utilization review programs on health care use and expenditures. N Engi J Med. 1988;318:1310–1314.Google Scholar
16.Avorn, J, Soumerai, SB, Taylor, W, et al: Reduction of incorrect antibiotic dosinr through a structured educational order loan. Arch Intern Med. 1988;148:1720–1724.Google Scholar
17.McCarthy, CM: DRGs—Five years later. N Engl J Med. 1988;318:1683–1686.Google Scholar
18.Ware, JE Jr., Brook, RH, Rogers, WH, et al: Comparison of outcomes at a health maintenance organization with those of fee-for-service care. Lancet. 1986;1:1017–1022.Google Scholar
19.Imperiale, TF, Siegal, AP, Credé, WB, et al: Preadmission screening of Medicare patients. The clinical impact of reimbursement disapproval. JAMA. 1988;259:3418–3421.CrossRefGoogle Scholar
20.Fitzgerald, JF, Fagan, LF, Tierney, WM, et al: Changing patterns of hip fracture care before and after implementation of the prospective payment system. JAMA. 1987;218–221.Google Scholar