Related Experiment Videos
An analysis of 25 Milliman & Robertson guidelines for surgery: data-driven versus consensus-derived clinical practice
1University of North Carolina School of Medicine, Chapel Hill, USA.
Summary Background Data:
Managed care guidelines such as those by Milliman & Robertson (M&R) are being implemented with increasing frequency. Many fellows of the American College of Surgeons have raised concerns that the targets set by the M&R guidelines are too aggressive. Uninformed attempts to reach these targets may harm patients. The primary hypothesis of this study was that many of the M&R guidelines are at wide variance from the actual length of stay of patients treated for these diseases.
Methods:
Data for the determination of the present practice of care for patients in 25 M&R guidelines were obtained from the hospital discharge data base for North Carolina for 1996. Twenty-five of the M&R guidelines were compared to the actual patient mean, mode, and median length of stay.
Results:
In 8 of the 25 patient groups, the difference between the actual mean length of stay and M&R guidelines exceeded 5 days.
Conclusions:
Many of the M&R guidelines were found to be at wide variance from the actual length of stay of patients treated for these diseases in North Carolina. For many patients, the M&R guidelines are not applicable. Applying them in an uninformed way--in other words, discharging patients from the hospital too early--may hurt some patients. This study should not be interpreted as a criticism of the trend to use guidelines in general; rather, it should be considered a cautionary note that all guidelines must be reviewed scientifically to determine their soundness, applicability, and credibility.
Insights
Managed care guidelines from Milliman & Robertson (M&R) often differ significantly from actual patient lengths of stay. Uninformed application of these aggressive M&R guidelines may pose risks to patient care.
Area of Science:
- Healthcare Management
- Surgical Outcomes
- Health Policy Analysis
Background:
- Managed care guidelines, including those from Milliman & Robertson (M&R), are increasingly adopted.
- Concerns exist among surgeons regarding the aggressive targets set by M&R guidelines.
- Potential patient harm is a risk if guidelines are implemented without considering actual patient needs.
Purpose of the Study:
- To evaluate the alignment between Milliman & Robertson (M&R) guidelines and actual patient lengths of stay.
- To identify discrepancies between recommended and observed hospital stays for various diseases.
Main Methods:
- Utilized North Carolina hospital discharge data from 1996 for 25 diseases covered by M&R guidelines.
- Compared the actual mean, mode, and median length of stay with the established M&R guideline targets.
Main Results:
- Significant variances were observed between actual lengths of stay and M&R guidelines for several patient groups.
- In 8 out of 25 patient groups analyzed, the difference between actual mean length of stay and M&R guidelines exceeded 5 days.
Conclusions:
- Many Milliman & Robertson (M&R) guidelines show considerable divergence from actual patient lengths of stay in North Carolina.
- The applicability of M&R guidelines is questionable for numerous patient cases.
- Caution is advised against uninformed application of M&R guidelines to prevent premature patient discharge and potential harm; scientific review of all guidelines is essential.