Efficiency gains in utilization review.
A study was conducted to determine which Major Diagnostic Categories (MDCs) accounted for most of the nonessential hospital admissions in 73 Michigan hospitals in 1986. The Intensity, Severity, Discharge-Appropriateness (ISD-A) criteria set was used to identify nonessential admissions. Large concentrations of nonessential admissions were found in medical, psychiatric, and substance abuse cases; surgical admissions had low rates of nonessential hospitalization. Focusing utilization review on MDCs with nonessential rates exceeding 15% results in an examination of 44% of admissions, while capturing 77% of nonessential admissions and 73% of potential dollar savings. Implications for UR activities are discussed.
Paranjpe
N
N
Michigan Health Care Education & Research Foundation, Detroit 48226.
Strumwasser
I
I
Ronis
D L
DL
Bartzack
C
C
Zech
C
C
D000367:Age Factors; D054598:Blue Cross Blue Shield Insurance Plans / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D004526:Efficiency; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008824:Michigan; D010343:Patient Admission / Q000706:statistics & numerical data; D014600:Utilization Review / Q000379:methods*