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Related Experiment Videos

Implementing practice guidelines through a utilization management strategy: the potential and the challenges.

A G Ellrodt1, L Conner, M S Riedinger

  • 1Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048.

QRB. Quality Review Bulletin
|December 1, 1992
PubMed
Summary
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Implementing practice guidelines using utilization management (UM) coordinators can effectively reduce hospital length of stay for low-risk chest pain patients. Rigorous assessment of UM coordinator accuracy is crucial for successful guideline implementation.

Area of Science:

  • Healthcare Management
  • Clinical Practice Guidelines
  • Patient Outcomes

Background:

  • Significant resources are dedicated to developing practice guidelines, yet their implementation remains a challenge.
  • Effective implementation strategies are needed to translate guideline recommendations into routine clinical practice.

Purpose of the Study:

  • To evaluate the effectiveness of a practice guideline in reducing hospital length of stay for low-risk chest pain patients.
  • To assess the role of Utilization Management (UM) coordinators in implementing clinical practice guidelines.

Main Methods:

  • A prospective interventional trial was conducted using a validated explicit practice guideline (decision aid).
  • UM coordinators and physicians implemented the guideline for 624 selected low-risk chest pain patients.

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  • Performance metrics included sensitivity, specificity, positive predictive value, and negative predictive value.

    • Main Results:

    • UM coordinators achieved a sensitivity of 0.85 and specificity of 0.90 in applying the guideline.
    • Physicians did not override 51% of the UM coordinator recommendations for low-risk patients.
    • No adverse outcomes were observed in patients discharged based on guideline recommendations at 30-day follow-up.

    Conclusions:

    • Utilization management is a feasible mechanism for implementing practice guidelines in hospitals.
    • Accurate implementation by UM coordinators requires rigorous assessment and a system of checks and balances.
    • Physicians retain ultimate responsibility for patient care decisions within a guideline-informed framework.