Skip to main content
PMC home page
Proceedings of the Annual Symposium on Computer Application in Medical Care logoLink to Proceedings of the Annual Symposium on Computer Application in Medical Care
. 1993:176–182.

Decision support for concurrent utilization review using a HELP-embedded expert system.

B D Nelson 1, R M Gardner 1
PMCID: PMC2248499  PMID: 8130457

Abstract

Utilization Review is the process of evaluating the efficiency of medical care, based on examination of the patient record. At LDS Hospital, the electronic patient record is in an advanced state. This paper describes the development and knowledge base verification of ASSURE (Automated Support System for Utilization Review), an application within the HELP hospital information system. ASSURE applies the Appropriateness Evaluation Protocol (AEP) Day of Care criteria to the electronic patient record, concurrent with the patient's stay. In blinded trials, an experienced Utilization Manager agreed with 92% of ASSURE's decisions on single AEP criteria for 560 acute care patients. Agreement was statistically significant, with kappa = 0.84, P < 0.0001.

Full text

PDF
176

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bradshaw K. E., Gardner R. M., Pryor T. A. Development of a computerized laboratory alerting system. Comput Biomed Res. 1989 Dec;22(6):575–587. doi: 10.1016/0010-4809(89)90077-3. [DOI] [PubMed] [Google Scholar]
  2. Evans R. S., Pestotnik S. L., Classen D. C., Bass S. B., Burke J. P. Prevention of adverse drug events through computerized surveillance. Proc Annu Symp Comput Appl Med Care. 1992:437–441. [PMC free article] [PubMed] [Google Scholar]
  3. Evans R. S., Pestotnik S. L., Classen D. C., Burke J. P. Development of an automated antibiotic consultant. MD Comput. 1993 Jan-Feb;10(1):17–22. [PubMed] [Google Scholar]
  4. Evans R. S. The HELP system: a review of clinical applications in infectious diseases and antibiotic use. MD Comput. 1991 Sep-Oct;8(5):282-8, 315. [PubMed] [Google Scholar]
  5. Feldstein P. J., Wickizer T. M., Wheeler J. R. Private cost containment. The effects of utilization review programs on health care use and expenditures. N Engl J Med. 1988 May 19;318(20):1310–1314. doi: 10.1056/NEJM198805193182006. [DOI] [PubMed] [Google Scholar]
  6. Franks P., Clancy C. M., Nutting P. A. Gatekeeping revisited--protecting patients from overtreatment. N Engl J Med. 1992 Aug 6;327(6):424–429. doi: 10.1056/NEJM199208063270613. [DOI] [PubMed] [Google Scholar]
  7. Gertman P. M., Restuccia J. D. The appropriateness evaluation protocol: a technique for assessing unnecessary days of hospital care. Med Care. 1981 Aug;19(8):855–871. [PubMed] [Google Scholar]
  8. Miller P. L., Sittig D. F. The evaluation of clinical decision support systems: what is necessary versus what is interesting. Med Inform (Lond) 1990 Jul-Sep;15(3):185–190. doi: 10.3109/14639239009025266. [DOI] [PubMed] [Google Scholar]
  9. Miller P. L. The evaluation of artificial intelligence systems in medicine. Comput Methods Programs Biomed. 1986 Mar;22(1):5–11. [PubMed] [Google Scholar]
  10. Payne S. M. Identifying and managing inappropriate hospital utilization: a policy synthesis. Health Serv Res. 1987 Dec;22(5):709–769. [PMC free article] [PubMed] [Google Scholar]
  11. Pryor T. A., Gardner R. M., Clayton P. D., Warner H. R. The HELP system. J Med Syst. 1983 Apr;7(2):87–102. doi: 10.1007/BF00995116. [DOI] [PubMed] [Google Scholar]
  12. Pryor T. A. The HELP medical record system. MD Comput. 1988 Sep-Oct;5(5):22–33. [PubMed] [Google Scholar]
  13. Restuccia J. D., Payne S. M., Lenhart G., Constantine H. P., Fulton J. P. Assessing the appropriateness of hospital utilization to improve efficiency and competitive position. Health Care Manage Rev. 1987 Summer;12(3):17–27. doi: 10.1097/00004010-198701230-00006. [DOI] [PubMed] [Google Scholar]
  14. Rosenstein A. H. Utilization review. Health economics and cost-effective resource management. Qual Assur Util Rev. 1991 Fall;6(3):85–90. doi: 10.1177/0885713x9100600305. [DOI] [PubMed] [Google Scholar]
  15. Schoolman H. M. Obligations of the expert system builder: meeting the needs of the user. MD Comput. 1991 Sep-Oct;8(5):316–321. [PubMed] [Google Scholar]
  16. Sittig D. F., Pace N. L., Gardner R. M., Beck E., Morris A. H. Implementation of a computerized patient advice system using the HELP clinical information system. Comput Biomed Res. 1989 Oct;22(5):474–487. doi: 10.1016/0010-4809(89)90040-2. [DOI] [PubMed] [Google Scholar]
  17. Wickizer T. M., Feldstein P. J., Wheeler J. R., McDonald M. C. Reducing hospital use and expenditures through utilization review. Findings from an outcome evaluation. Qual Assur Util Rev. 1990 Aug;5(3):80–85. doi: 10.1177/0885713x9000500303. [DOI] [PubMed] [Google Scholar]
  18. Wickizer T. M., Wheeler J. R., Feldstein P. J. Does utilization review reduce unnecessary hospital care and contain costs? Med Care. 1989 Jun;27(6):632–647. doi: 10.1097/00005650-198906000-00006. [DOI] [PubMed] [Google Scholar]

Articles from Proceedings of the Annual Symposium on Computer Application in Medical Care are provided here courtesy of American Medical Informatics Association

RESOURCES