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PubMed · 2535583

Efficiency gains in utilization review.

N Paranjpe·I Strumwasser·D L Ronis·C Bartzack·C Zech
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Abstract

A study was conducted to determine which Major Diagnostic Categories (MDCs) accounted for most of the nonessential hospital admissions in 73 Michigan hospitals in 1986. The Intensity, Severity, Discharge-Appropriateness (ISD-A) criteria set was used to identify nonessential admissions. Large concentrations of nonessential admissions were found in medical, psychiatric, and substance abuse cases; surgical admissions had low rates of nonessential hospitalization. Focusing utilization review on MDCs with nonessential rates exceeding 15% results in an examination of 44% of admissions, while capturing 77% of nonessential admissions and 73% of potential dollar savings. Implications for UR activities are discussed.

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Age FactorsBlue Cross Blue Shield Insurance PlansDiagnosis-Related GroupsEfficiencyHealth Services MisuseHospitalsHumansMichiganPatient AdmissionUtilization ReviewJournal Article

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N Paranjpe, I Strumwasser, D L Ronis, C Bartzack, C Zech. 1989. Efficiency gains in utilization review.. https://doi.org/10.1177/0885713x8900400404

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