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Computerized decision support for concurrent utilization review using the HELP system

B D Nelson1, R M Gardner, G Hedrick

  • 1Medical Informatics Department, University of Utah, Salt Lake City, USA.

Journal of the American Medical Informatics Association : JAMIA
|July 1, 1994
PubMed
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The Automated Support System for Utilization Review (ASSURE) effectively identifies potentially inappropriate patient care days using a computerized database. This tool aids in reducing healthcare costs by improving the efficiency of utilization review.

Area of Science:

  • Health Informatics
  • Clinical Decision Support Systems
  • Healthcare Management

Background:

  • Concurrent utilization review (UR) is crucial for managing healthcare resources and costs.
  • Existing UR processes can be time-consuming and resource-intensive.
  • Leveraging clinical data within hospital information systems offers potential for automated support.

Purpose of the Study:

  • To develop and evaluate a computerized system, the Automated Support System for Utilization Review (ASSURE), for concurrent UR.
  • To utilize a clinically rich computerized patient database to enhance UR processes.
  • To assess the accuracy and usefulness of ASSURE in identifying inappropriate patient days of care.

Main Methods:

  • ASSURE was developed to apply Appropriateness Evaluation Protocol (AEP) Day of Care criteria to patient data in the HELP hospital information system.

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  • Implementation correctness was verified by comparing ASSURE's criteria agreement with nurse reviewers for 560 inpatients.
  • Usefulness was validated by assessing reviewer agreement, sensitivity, specificity, and predictive values for 168 inpatients using a blocked design.

    • Main Results:

    • ASSURE demonstrated very good agreement for criteria satisfaction and good agreement for appropriateness of care days.
    • Patient days flagged by ASSURE as potentially inappropriate were twice as likely to be deemed inappropriate by reviewers.
    • Reviewing the 10% of days identified by ASSURE captured approximately 21% of all inappropriate care days.

    Conclusions:

    • ASSURE is a clinically useful tool for screening adult acute care patients for inappropriate days of care.
    • The system shows promise for significantly contributing to healthcare cost reduction.
    • The prognosis for the routine clinical implementation of ASSURE is favorable.