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Guidelines for the practice of utilization review: essential but lacking
1Florida Mental Health Institute, University of South Florida, Tampa.
QRB. Quality Review Bulletin
|April 1, 1990
Summary
Utilization review (UR) is becoming a distinct profession but lacks specific practice guidelines. This study proposes guidelines to ensure practitioners align with UR objectives, preventing misuse of unrelated professional standards.
Area of Science:
- Healthcare Management
- Professional Practice Standards
Background:
- Utilization review (UR) is evolving into a specialized profession.
- Current lack of established practice guidelines for UR practitioners.
- Risk of applying inappropriate guidelines from original or unrelated professions.
Purpose of the Study:
- To address the absence of professional standards in utilization review.
- To propose a set of practice guidelines for UR practitioners.
- To facilitate the development of consensus-based UR principles.
Main Methods:
- Review of existing professional practices.
- Identification of potential conflicts with UR objectives.
- Development of proposed practice guidelines for UR.
Main Results:
- Identified a critical need for UR-specific practice guidelines.
- Presented a foundational set of proposed guidelines for professional consensus.
- Highlighted the importance of UR-aligned principles.
Conclusions:
- Utilization review requires dedicated practice guidelines for effective and ethical operation.
- Professional consensus is essential for developing and adopting UR standards.
- The proposed guidelines serve as a starting point for establishing UR as a recognized profession.
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