Designing a guideline-based utilization management program.
Many public and private organizations are developing and publishing clinical guidelines to assist health care providers and patients in making appropriate medical decisions. Unless clinical guidelines are part of a well-designed managed care program, they have little effect on physician practice styles. This article explores integral components of an effective guideline-based utilization management program. Initial evaluation of this program suggests that, as part of a well-designed utilization management program, clinical guidelines can inform patients and physicians, and create appropriate incentives for effective health care delivery.
Wilson
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Scheibner
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Winslow
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D002985:Clinical Protocols; D003363:Cost Control / Q000379:methods; D005568:Forms and Records Control; D007221:Industry / Q000592:standards; D007343:Insurance Carriers; D008329:Managed Care Programs / Q000191:economics / Q000592:standards*; D010934:Planning Techniques; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards*; D016730:Program Development / Q000379:methods; D012017:Referral and Consultation / Q000592:standards; D014481:United States; D014600:Utilization Review / Q000379:methods*