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Related Experiment Videos

Toward effective hospital utilization management. Ten lessons from case studies.

D G Smith1, B W Perry

  • 1Department of Health Services Management and Policy, School of Public Health, University of Michigan, Ann Arbor 48109-2029.

American Journal of Medical Quality : the Official Journal of the American College of Medical Quality
|January 1, 1992
PubMed
Summary

Hospitals are enhancing internal utilization management programs to navigate managed care and third-party controls. Case studies offer insights into adapting these programs effectively within diverse hospital environments.

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Area of Science:

  • Healthcare Management
  • Hospital Administration
  • Health Services Research

Background:

  • Managed care and third-party utilization controls present significant challenges to hospitals.
  • Hospitals are compelled to strengthen their internal utilization management (UM) programs in response.

Purpose of the Study:

  • To investigate how hospitals adapt their utilization management programs to environmental challenges.
  • To identify lessons learned from hospital case studies for improving UM programs.

Main Methods:

  • The study employed a case study methodology.
  • Findings were derived from an analysis of multiple hospital settings.

Main Results:

  • Hospitals have implemented varied strategies to adapt their UM programs.

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  • Adaptation of UM programs is influenced by specific hospital environments.

    • Conclusions:

    • Lessons from these case studies can inform hospitals seeking to improve their utilization management.
    • Strategic adaptation of UM programs is crucial for hospitals facing external pressures.