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The elements of a concurrent integrated UR-QR management system, Part two
Journal of Quality Assurance : a Publication of the National Association of Quality Assurance Professionals
|February 4, 1988
Summary
Concurrent integrated utilization review (UR) and quality (QR) management is crucial for fiscal solvency under Diagnosis-Related Group (DRG) prospective payment. However, most facilities lack these integrated programs, hindering efficiency and problem resolution.
Area of Science:
- Healthcare Management
- Health Services Research
- Quality Improvement
Background:
- Diagnosis-Related Group (DRG) prospective payment necessitates efficient healthcare management.
- Current practices often departmentalize utilization review (UR) and quality (QR) functions.
- This departmentalization leads to inefficiencies and hinders effective problem resolution.
Purpose of the Study:
- To underscore the importance of concurrent integrated UR-QR management.
- To highlight the need for coordinated interdepartmental UR-QR management.
- To advocate for integrated programs supporting fiscal solvency and operational efficiency.
Main Methods:
- The study is based on previous discussions and established principles of healthcare management.
- It analyzes the impact of DRG prospective payment on management structures.
- It evaluates the benefits of integrated UR-QR programs versus departmentalized approaches.
Main Results:
- Concurrent integrated UR-QR management enhances control over units of service.
- Integrated programs are vital for achieving fiscal solvency under DRG payment models.
- The majority of acute care facilities lack such integrated management systems.
Conclusions:
- Integrated UR-QR management is essential for acute care facilities operating under DRG prospective payment.
- Departmentalizing UR and QR functions compromises efficiency, cost-effectiveness, and problem resolution.
- Adopting concurrent integrated UR-QR management supports institutional financial health and operational effectiveness.
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