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Computerized Decision Support for Concurrent Utilization Review Using the HELP System

Computerized Decision Support for Concurrent Utilization Review Using the HELP System Abstract Objective: Development and evaluation of computerized concurrent utilization review (UR) support taking advantage of a clinically rich computerized patient database. Design: The Automated Support System for Utilization REview (ASSURE) applies the Appropriateness Evaluation Protocol(AEP) Day of Care criteria to computerized patient data in the HELP hospital information system. This paper reports the development, verification, and validation of ASSURE. Measurements: Implementation correctness was verified by measuring agreement with a nurse reviewer, using separate sample sets for all 20 criteria for a total of 560 current inpatients. Usefulness in detecting inappropriate days of care was validated by two nurse reviewers who were crossed with manual and computer-assisted review methods in a blocked design for 168 current inpatients. Agreement with reviewers, sensitivity, specificity, positive predictive value, and negative predictive value were measured. Results: Agreement was very good for satisfaction of criteria, and good for appropriateness of day of care. A patient day identified by ASSURE as potentially inappropriate would be twice as likely to be judged inappropriate by a reviewer as a randomly selected patient day. Review of the 10% of patient days identified as potentially inappropriate by ASSURE would identify approximately 21% of the inappropriate days of care. Conclusion: ASSURE is a clinically useful tool for screening adult acute care patients for inappropriate days of care, and promises to make a major contribution to reducing health care costs. The prognosis for successful routine clinical use is good. This content is only available as a PDF. Author notes Presented in part as a Student Paper Competition Finalist at the Symposium on Computer Applications in Medical Care, November 1993. Awarded First prize for Greater than One Year Projects. American Medical Informatics Association http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of the American Medical Informatics Association Oxford University Press

Computerized Decision Support for Concurrent Utilization Review Using the HELP System

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References (25)

Publisher
Oxford University Press
Copyright
American Medical Informatics Association
ISSN
1067-5027
eISSN
1527-974X
DOI
10.1136/jamia.1994.95236169
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: Development and evaluation of computerized concurrent utilization review (UR) support taking advantage of a clinically rich computerized patient database. Design: The Automated Support System for Utilization REview (ASSURE) applies the Appropriateness Evaluation Protocol(AEP) Day of Care criteria to computerized patient data in the HELP hospital information system. This paper reports the development, verification, and validation of ASSURE. Measurements: Implementation correctness was verified by measuring agreement with a nurse reviewer, using separate sample sets for all 20 criteria for a total of 560 current inpatients. Usefulness in detecting inappropriate days of care was validated by two nurse reviewers who were crossed with manual and computer-assisted review methods in a blocked design for 168 current inpatients. Agreement with reviewers, sensitivity, specificity, positive predictive value, and negative predictive value were measured. Results: Agreement was very good for satisfaction of criteria, and good for appropriateness of day of care. A patient day identified by ASSURE as potentially inappropriate would be twice as likely to be judged inappropriate by a reviewer as a randomly selected patient day. Review of the 10% of patient days identified as potentially inappropriate by ASSURE would identify approximately 21% of the inappropriate days of care. Conclusion: ASSURE is a clinically useful tool for screening adult acute care patients for inappropriate days of care, and promises to make a major contribution to reducing health care costs. The prognosis for successful routine clinical use is good. This content is only available as a PDF. Author notes Presented in part as a Student Paper Competition Finalist at the Symposium on Computer Applications in Medical Care, November 1993. Awarded First prize for Greater than One Year Projects. American Medical Informatics Association

Journal

Journal of the American Medical Informatics AssociationOxford University Press

Published: Jul 1, 1994

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