Context. - Utilization review (UR) seeks to improve quality and cost-efficiency of health care.
However, how well the process works in practice has not been assessed.
- To describe the outcomes of a sample of physician reviews in terms of the explicit criteria that the UR was designed to implement.
- Retrospective analysis of transcripts of precertification reviews.
- California physicians employed by a UR firm conducted 96 interviews from April 1990 to July 1991 with attending physicians who had proposed to insert tympanostomy tubes on a patient younger than 16 years and whose proposals had been found to be inappropriate on an initial screen.
- The appropriateness rating assigned to each case by the physician-reviewer and by the investigators using explicit criteria.
Logistic regression identified factors associated with the reviewers'recommendations to perform surgery and with recommendations at variance from the criteria.
- The reviewers recommended 78% of cases for surgery, of which only 29% were supported by the criteria or had extenuating circumstances.
The criteria concurred with all 30 of the reviewers'recommendations against surgery.
Two factors, female sex (odds ratio [OR], 8.2 ; 95% confidence interval [Cl], 1.2-53.8) and previous tympanostomy tube insertion (OR, 30.9 ; 95% Cl, 2.4-394. (...)
Mots-clés Pascal : Soin intégré, Qualité, Soin, Analyse coût efficacité, Article synthèse, Recommandation, Médecin, Pratique professionnelle, Choix, Epidémiologie, Evaluation, Homme, Personnel sanitaire
Mots-clés Pascal anglais : Managed care, Quality, Care, Cost efficiency analysis, Review, Recommendation, Physician, Professional practice, Choice, Epidemiology, Evaluation, Human, Health staff
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0433152
Code Inist : 002B30A01C. Création : 19/12/1997.