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Utilization review based on practitioner profiles
Journal of Medical Systems
|October 1, 1983
Summary
This study introduces practitioner profiles to assess hospital length of stay, leading to a significant reduction in average patient days and overall healthcare utilization.
Area of Science:
- Healthcare Management
- Health Services Research
- Quality Improvement
Background:
- Traditional utilization reviews focus on patient diagnoses or services.
- Practitioner practice patterns significantly influence patient length of stay.
- A need exists for targeted review strategies to optimize hospital resource utilization.
Purpose of the Study:
- To develop and evaluate a practitioner-profiling system for utilization review.
- To assess the impact of practitioner-focused review on patient length of stay.
- To identify opportunities for improving healthcare efficiency through targeted interventions.
Main Methods:
- Developed practitioner profiles comparing case-mix-adjusted length of stay to statewide norms.
- Utilized diagnosis-related groups (DRGs) for case-mix adjustment.
- Established adjustable standards for acceptable variation from length-of-stay norms.
Main Results:
- Implementation of practitioner profiles led to a significant decrease in average length of stay.
- A substantial reduction in total patient days was observed.
- The review process demonstrated effectiveness in modifying practice patterns.
Conclusions:
- Practitioner profiling is an effective strategy for focused utilization review.
- This approach can significantly reduce hospital length of stay and patient days.
- Targeting practitioner behavior offers a viable pathway for healthcare cost containment and efficiency gains.
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