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  1. Adherence to prescribed explicit criteria during utilization review : An analysis of communications between attending and reviewing physicians.

    Article - En anglais

    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.

    Objective

    - To describe the outcomes of a sample of physician reviews in terms of the explicit criteria that the UR was designed to implement.

    Design

    - Retrospective analysis of transcripts of precertification reviews.

    Participants and Setting

    - 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.

    Main Outcome Measures

    - 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.

    Results

    - 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

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 97-0433152

    Code Inist : 002B30A01C. Création : 19/12/1997.