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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.
Annals of Surgery
|October 28, 1998
Summary
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.