Integrated Quality Assessment: A Model for Concurrent Review

Longo, Daniel R.; Ciccone, Kathleen R.; Jonathan, T.

doi:10.1111/j.1945-1474.1994.tb00735.x

Cited by 2 publications

(3 citation statements)

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“…Initially developed to serve as a &dquo;early warning&dquo; function to identify medical malpractice claims, this approach was greatly expanded by Craddick (26) in her Medical Management Analysis approach (41). This was later incorporated by Longo et al into the Integrated Quality Assessment Model (IQA) that went beyond risk management and integrated it with medical staff quality assurance, utilization review, and infection control (19,53). Later, IQA-2 was developed at the Hospital Association of New York State as an adjunct to IQA to incorporate the theories of CQI/TQM (52).…”

Section: Quality Measurementmentioning

confidence: 99%

Measuring the Quality of Care: Reforming the Health Care System

Longo

Daugird

1994

Am J Med Qual

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Elements of meaningful health care reform must include the ability of patients, providers, and payers to select services offering quality care at an affordable price. To achieve this goal, an appropriate definition of quality needs to be articulated and adopted; data capturing the definition needs to be collected; and appropriate measures need to be selected to analyze that data. Results need to be publically available to assist in making informed choices. The health professions need to fulfill their social contract. And, government needs to ensure that public safety and accountability are maintained and preserved. While the goals and strategies of the different players in the health care arena may be different, there is one thing in common--the needs of citizens must be met through the provision of available, accessible, quality, equitable, and cost-effective health care. These values need to be incorporated into a reform plan. Currently, our ability to comprehensively, consistently, and uniformly perform these tasks is severely limited. While many diverse factors, such as the limitation of financial support and the lack of uniform information systems, contribute to this situation, we believe it is possible through the implementation of a series of recommendations to achieve these goals. This paper outlines the current situation, reviews insights derived from the literature and past and current experiences. Recommendations are made that apply equally to health reform efforts at the state and/or federal levels.

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Section: Quality Measurementmentioning

confidence: 99%

Measuring the Quality of Care: Reforming the Health Care System

Longo

Daugird

1994

Am J Med Qual

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“…A hospital's general strategy is the set of fundamental policies that guide the structure and operation of utilization management activities (8). These policies are typically developed or revised by the hospital's utilization review committee, which includes representatives from quality assurance, medical staff, and administration.…”

Section: General Utilization Management Strategymentioning

confidence: 99%

“…Have at least one person in a key leadership role on the medical staff interested in the hospital's utilization management experience and committed to helping the hospital and the medical staff work together in developing long-run, strategic responses; 7. Hire, train, and supervise utilization management staff who understand their role and the goals of the department in the larger context of the hospital's needs and its relationship with the medical staff; 8. Generate relevant information that flows well among managers and physicians responsible for quality assurance, infection control, risk management, medical records, patient accounts, discharge planning, and utilization management; 9.…”

Section: Lessons Learnedmentioning

confidence: 99%

Toward Effective Hospital Utilization Management

Smith

Perry

1992

Quality Assurance and Utilization Review

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The challenges presented by managed care arrangements and third-party utilization controls have led hospitals to strengthen internal utilization management programs. This article reports findings from a set of case studies on how hospitals have adapted their utilization management programs to their environments. While knowledge acquired from case studies should not be overgeneralized, the findings of these studies suggest some lessons that merit consideration by hospitals advancing their own programs in utilization management.Utilization management is usually defined as a program to ensure that hospital admissions are clinically appropriate, that medical services are provided in accordance with norms of practice, and that guidelines for reimbursement are followed. The literature contains a growing number of case studies of effective utilization review programs. For example, Mozes et al.(1) found that the application of standardized criteria through daily review at one hospital reduced average length of stay by nearly two days. Catchpole (2) found that the introduction of a utilization management program reduced lengths of stay for 70% of matched cases. And Woodside et al. (3) found that an intensive review program reduced lengths of stay by almost three days.Despite these case studies and the great number of articles, books, and guidelines that have been written on how the mechanics of the utilization reuiew process operates, precious little attention has been paid to how the entire utilization management program should relate to broader hospital strategies, including physician-hospital relations. Do some general principles exist in designing effective utilization management programs, or does each hospital require a unique approach?As a step toward understanding how various elements of hospital utilization management programs contribute to effective results, case studies of Michigan hospitals were conducted in cooperation with the Sisters of Mercy, Farmington Hills. The purpose of these studies was to identify relevant factors, in addition to the mechanics of utilization review, that contributed to effective operations. Preparing the case studies involved reviewing internal and external reports on utilization experience, interviewing hospital personnel associated with utilization management programs and general administration, and interviewing representatives of third parties involved in hospital reimbursement and utilization review.Following a brief description of environmental conditions in Michigan common to all study hospitals, findings in five areas of hospital utilization management programs are presented along with ten lessons for effective utilization management. While knowledge acquired from case studies should not be overgeneralized, we believe that these lessons merit consideration by hospitals interested in advancing their own utilization management programs.

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Integrated Quality Assessment: A Model for Concurrent Review

Cited by 2 publications

References 0 publications

Measuring the Quality of Care: Reforming the Health Care System

Measuring the Quality of Care: Reforming the Health Care System

Toward Effective Hospital Utilization Management

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