Design and development of a utilization review program in Portugal.
This paper describes the work that has been under way in the Portuguese government hospital sector, with respect to the use of an adapted version of the Appropriateness Evaluation Protocol (AEP). Modifications to the original system were determined through a series of experiments at pilot hospitals and reliability and user profile studies were subsequently conducted using the modified criteria. Results were of great value in terms of the identification and quantification of problems. On average, approximately one in every four non-obstetric admissions and one in every 2 days of stay were deemed inappropriate and 75% of all inappropriate days were related to patients who were ready for discharge. It is expected that the use of the modified AEP will be extended and enhanced over the next few years. In this regard, advantage has already been taken of the implementation of an output-based funding system, combining retrospective statistical analysis of the hospitals' inpatient databases with targeted reviews of individual patients.
Bentes
M
M
Departamento de Desenvolvimento de Sistemas de Financiamento e de Gestão, Instituto de Gestão Informática e Financeira da Saúde, Lisbon, Portugal.
Gonsalves
M L
ML
Santos
M
M
Pina
E
E
D006302:Health Services Research; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D010865:Pilot Projects; D011174:Portugal; D016730:Program Development; D015203:Reproducibility of Results; D012107:Research Design; D012189:Retrospective Studies; D014600:Utilization Review / Q000458:organization & administration*