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Related Experiment Videos

Decision support for concurrent utilization review using a HELP-embedded expert system

B D Nelson1, R M Gardner

  • 1Department of Medical Informatics, LDS Hospital/University of Utah, Salt Lake City.

Proceedings. Symposium on Computer Applications in Medical Care
|January 1, 1993
PubMed
Summary
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Automated Support System for Utilization Review (ASSURE) accurately evaluates medical care efficiency using electronic health records. ASSURE achieved 92% agreement with expert reviewers, demonstrating its effectiveness in concurrent patient care reviews.

Area of Science:

  • Health Informatics
  • Medical Quality Assurance
  • Clinical Decision Support

Background:

  • Utilization Review (UR) assesses medical care efficiency via patient records.
  • LDS Hospital utilizes an advanced electronic patient record system.
  • Existing UR processes can be time-consuming and resource-intensive.

Purpose of the Study:

  • To develop and verify ASSURE (Automated Support System for Utilization Review).
  • To integrate ASSURE within the HELP hospital information system.
  • To evaluate ASSURE's accuracy in applying Appropriateness Evaluation Protocol (AEP) criteria.

Main Methods:

  • Development of the ASSURE application.
  • Implementation of the Appropriateness Evaluation Protocol (AEP) Day of Care criteria.

Related Experiment Videos

  • Knowledge base verification through blinded trials comparing ASSURE to expert Utilization Managers.

    • Main Results:

    • ASSURE demonstrated high agreement (92%) with expert Utilization Managers on AEP criteria.
    • Statistical analysis showed significant agreement (kappa = 0.84, P < 0.0001).
    • The system performed concurrent reviews of electronic patient records during patient stays.

    Conclusions:

    • ASSURE is an effective automated tool for concurrent utilization review.
    • The system leverages advanced electronic patient records for efficient medical care evaluation.
    • ASSURE shows strong potential for improving UR accuracy and efficiency in hospital settings.