An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.
Review of the medical necessity of hospital or other health facility admissions, upon or within a short time following an admission, and periodic review of services provided during the course of treatment.
Formal programs for assessing drug prescription against some standard. Drug utilization review may consider clinical appropriateness, cost effectiveness, and, in some cases, outcomes. Review is usually retrospective, but some analysis may be done before drugs are dispensed (as in computer systems which advise physicians when prescriptions are entered). Drug utilization review is mandated for Medicaid programs beginning in 1993.
Health insurance providing benefits to cover or partly cover hospital expenses.
Excessive, under or unnecessary utilization of health services by patients or physicians.
I'm sorry for any confusion, but "Utah" is a proper noun and refers to a state in the United States, it does not have a medical definition. If you have any medical questions or need information on specific medical conditions or terms, I would be happy to help!
Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.
Planning for health resources at a regional or multi-state level.
Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.
Institutions with an organized medical staff which provide medical care to patients.
The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)
The period of confinement of a patient to a hospital or other health facility.
The term "United States" in a medical context often refers to the country where a patient or study participant resides, and is not a medical term per se, but relevant for epidemiological studies, healthcare policies, and understanding differences in disease prevalence, treatment patterns, and health outcomes across various geographic locations.

Reliability of a hospital utilization review method in Turkey. (1/751)

OBJECTIVE: To determine whether the Appropriateness Evaluation Protocol (AEP) is reliable in Turkey. METHODS: Three reviewers, two physicians and one nurse each reviewed 196 patient-days concurrently by using the AEP at three hospitals, two of which were teaching hospitals. Inter-reviewer reliability was assessed both for all cases reviewed (overall agreement), and for only those judged inappropriate by at least one reviewer (specific agreement). In addition, overall agreement between pairs of reviewers was evaluated by the Kappa statistic. RESULTS: The overall agreement between pairs of reviewers was very high: 93.4-95.9%, and it was similar between all pairs. The level of overall agreement was highly statistically significant: k=0.725-0.833, P<0.001. The specific agreement rates ranged from a low of 61.8% to a high of 75%. CONCLUSIONS: These results show, for the first time, that the AEP method is reliable in Turkey.  (+info)

Audit of bronchial artery embolisation in a specialist respiratory centre. (2/751)

OBJECTIVE: To audit the use of bronchial arteriography and embolisation for controlling haemoptysis. DESIGN: Retrospective review of radiological and clinical data. SETTING: Brompton and National Heart Hospitals. PATIENTS: 35 patients with severe pulmonary disease in whom 58 bronchial arteriograms were obtained between 1 January 1984 and 31 December 1989 with the intention of bronchial artery embolisation for controlling haemoptysis. MAIN MEASURES: Rate of technical success and cessation of haemoptysis; detailed evaluation of patients, particularly those with major haemoptysis (> 100 ml expectorated blood); and retrospective assessment of the appropriateness of the procedure in each. RESULTS: 58 procedures were performed, nine of which were unsuitable for detailed analysis. Nine procedures were for minor haemoptysis, which subsequently recurred, and 40 for recent major haemoptysis in 26 patients with cystic fibrosis (16) aspergilloma (six), bronchiectasis (three), and an unknown diagnosis (one). The median total volume of haemoptysis in the episode before the procedure was 680 ml (range 270-2200 ml). Embolisation was technically successful in 33/40 procedures, in 17 of which, however, major haemoptysis recurred within 10 days of the procedure, leaving 16 clinically and technically successful procedures in 15 patients. Five patients (three with aspergilloma, two with cystic fibrosis) died of haemoptysis despite attempted embolisation. CONCLUSION: Success rate of bronchial artery embolisation was 40%(16/40). IMPLICATIONS: Bronchial artery embolisation is probably not justified for minor haemoptysis or when performed more than one week after a major haemoptysis. Repeat arteriograms during a single period of haemoptysis are seldom useful. With these criteria 43% fewer procedures would have been performed with no loss of clinical benefit.  (+info)

User charges in government health facilities in Kenya: effect on attendance and revenue. (3/751)

In this paper we study demand effects of user charges in a district health care system using cross-sectional data from household and facility surveys. The effects are examined in public as well as in private health facilities. We also look briefly at the impact of fees on revenue and service quality in government facilities. During the period of cost-sharing in public clinics, attendance dropped by about 50%. This drop prompted the government to suspend the fees for approximately 20 months. Over the 7 months after suspension of fees, attendance at government health centres increased by 41%. The suspension further caused a notable movement of patients from the private sector to government health facilities. The revenue generated by user fees covered 2.4% of the recurrent health budget. Some 40% of the facilities did not spend the fee revenue they collected, mainly due to cumbersome procedures of expenditure approvals. The paper concludes with lessons from Kenya's experience with user charges.  (+info)

Health services research in the English-speaking Caribbean 1984-93: a quantitative review. (4/751)

Evaluating the effectiveness and efficiency of health services is important for all countries, especially those with limited resources. This study aimed to evaluate the volume and quality of health services research (HSR) conducted in one developing region, the English-speaking Caribbean. Data were abstracted from all 770 abstracts describing presentations at the annual scientific meetings of the Commonwealth Caribbean Medical Research Council for the decade 1984 to 1993. Of these, 341 abstracts were judged to report health services research and were from the English-speaking Caribbean. Hospital services were evaluated in 240 (70%) reports while primary health services were evaluated in only 90 (26%). Most hospital-based studies evaluated the use and outcome of medical and surgical services through the collection of case series and cohorts of cases, with a median sample size of 104 (interquartile range 38 to 320). Evaluations at primary level were more likely to evaluate need or demand for services, were more likely to report cross sectional surveys or randomized trials and included larger numbers of subjects (median 343, interquartile range 121 to 661). Patient-based measures of health status and measures of resource use were not often reported at either primary or secondary level. Estimation and hypothesis testing were infrequently employed in data analysis. A large proportion of the research presented could be classified as HSR but measures are needed to increase the motivation for research into primary care and to improve skills in HSR study design, conduct and analysis among those presently conducting research.  (+info)

The fall and rise of cost sharing in Kenya: the impact of phased implementation. (5/751)

The combined effects of increasing demand for health services and declining real public resources have recently led many governments in the developing world to explore various health financing alternatives. Faced with a significant decline during the 1980s in its real per capita expenditures, the Kenya Ministry of Health (MOH) introduced a new cost sharing programme in December 1989. The programme was part of a comprehensive health financing strategy which also included social insurance, efficiency measures, and private sector development. Early implementation problems led to the suspension in September 1990 of the outpatient registration fee, the major revenue source at the time. In 1991, the Ministry initiated a programme of management improvement and gradual re-introduction of an outpatient fee, but this time as a treatment fee. The new programme was carried out in phases, beginning at the national and provincial levels and proceeding to the local level. The impact of these changes was assessed with national revenue collection reports, quality of care surveys in 6 purposively selected indicator districts, and time series analysis of monthly utilization in these same districts. In contrast to the significant fall in revenue experienced over the period of the initial programme, the later management improvements and fee adjustments resulted in steady increases in revenue. As a percentage of total non-staff expenditures, fiscal year 1993-1994 revenue is estimated to have been 37% at provincial general hospitals, 20% at smaller hospitals, and 21% at health centres. Roughly one third of total revenue is derived from national insurance claims. Quality of care measures, though in some respects improved with cost sharing, were in general somewhat mixed and inconsistent. The 1989 outpatient registration fee led to an average reduction in utilization of 27% at provincial hospitals, 45% at district hospitals, and 33% at health centres. In contrast, phased introduction of the outpatient treatment fee beginning in 1992, combined with somewhat broader exemptions, was associated with much smaller decreases in outpatient utilization. It is suggested that implementing user fees in phases by level of health facility is important to gain patient acceptance, to develop the requisite management systems, and to orient ministry staff to the new systems.  (+info)

Use of PRISM scores in triage of pediatric patients with diabetic ketoacidosis. (6/751)

Triage guidelines are needed to help in the decision process of intensive care unit (ICU) versus non-ICU admission for patients with diabetic ketoacidosis (DKA). Pediatric risk of mortality (PRISM) scores have long been used to assess mortality risk. This study assess the usefulness of the traditional PRISM score and adaptation of that score (PRISM-ED, which uses presentation data only) in predicting hospital stay in pediatric patients with DKA. PRISM and PRISM-ED were tested for correlation with length of stay and length of ICU stay. A medical record review was conducted for patients admitted to The Children's Hospital of Alabama with DKA during an 18-month period (n = 79). Two scores were calculated for each study entrant: PRISM using the worst recorded values over the first 24 hours and PRISM-ED using arrival values. Median scores, median test, and Spearman rank correlations were determined for both tests. Median PRISM scores were PRISM = 11 and PRISM-ED = 12; Median PRISM and PRISM-ED scores for patients admitted to the ICU were less than median scores among floor-admitted patients: [table: see text] Spearman rank correlations were significant for both scores versus total stay: PRISM, rs = 0.29; P = 0.009; PRISM-ED, rs = 0.60, P < 0.001. Also, correlations were significant for both scores versus ICU stay: PRISM rs = 0.22, P = 0.05; PRISM-ED, rs = 0.41, P < 0.001. Triage guidelines for ICU versus floor admission for DKA patients could have significant economic impact (mean ICU charge = $11,417; mean charge for floor admission = $4,447). PRISM scores may be an important variable to include in a multiple regression model used to predict the need for ICU monitoring.  (+info)

Impact of managed care on quality of healthcare: theory and evidence. (7/751)

Each strategy for managing healthcare risk has important and unique implications for the patient-provider relationship and for quality of care. Not only are different incentive structures created by different risk-sharing arrangements, but these incentives differ from those in a fee-for-service environment. With fee-for-service and traditional indemnity insurance, physicians have incentives to provide healthcare services of marginal value to the patient; under managed care, physicians have fewer incentives to provide marginally beneficial services. However, the impact of financial arrangements on quality of care remains ambiguous, because it depends on the strategic behavior of physicians with regard to their informational advantage over their patients. Using the framework of an agency theory model, we surveyed the current scientific literature to assess the impact of managed care on quality of care. We considered three different dimensions of quality of care: patient satisfaction, clinical process and outcomes of care measures, and resource utilization. Although we found no systematic differences in patient satisfaction and clinical process and outcomes between managed care and fee-for-service plans, resource utilization appears to be decreased under managed care arrangements. Given the strengths and weaknesses of fee-for-service and managed care, it is unlikely that either will displace the other as the exclusive mechanism for arranging health insurance contracts. Policy makers may be able to take advantage of the strengths of both fee-for-service and managed care financial arrangements.  (+info)

Comparison of NHS and private patients undergoing elective transurethral resection of the prostate for benign prostatic hypertrophy. (8/751)

OBJECTIVES: To compare the operative thresholds and clinical management of men undergoing elective transurethral resection of the prostate for benign prostatic hypertrophy in the NHS and privately. DESIGN: Cohort study of patients recruited by 25 surgeons during 1988. SETTING: Hospitals in Oxford and North West Thames regions. PATIENTS: Of 400 consecutive patients, 129 were excluded because of open surgery (nine), lack of surgeons' information (three), and emergency admission (117) and three failed to give information, leaving 268 patients, 214 NHS patients and 54 private patients. MAIN MEASURES: Sociodemographic factors, prevalence and severity of symptoms, comorbidity, general health (Nottingham health profile) obtained from patient questionnaire preoperatively and reasons for operating, and operative management obtained from surgeons perioperatively. RESULTS: NHS and private patients were similar in severity of symptoms and prevalence of urinary tract abnormalities. They differed in four respects: NHS patients' general health was poorer as a consequence of more comorbid conditions (49, 23% v 7, 13% in severe category); the condition had a greater detrimental effect on their lives (36, 17% v 2, 4% severely affected; p < 0.01); private patients received more personalised care more quickly and were investigated more before surgery, (29, 54% v 60, 20% receiving ultrasonography of the urinary tract); and NHS patients stayed in hospital longer (57, 27% v 3, 6% more than seven days; p < 0.001). CONCLUSIONS: Private patients' need for surgery, judged by symptom severity, was as great as that of NHS patients, and there was no evidence of different operative thresholds in the two sectors, but, judged by impact on lifestyle, NHS patients' need was greater.  (+info)

Utilization review (UR) is a comprehensive process used by healthcare insurance companies to evaluate the medical necessity, appropriateness, and efficiency of the healthcare services and treatments that have been rendered, are currently being provided, or are being recommended for members. The primary goal of utilization review is to ensure that patients receive clinically necessary and cost-effective care while avoiding unnecessary or excessive treatments.

The utilization review process may involve various steps, including:

1. Preauthorization (also known as precertification): A prospective review to approve or deny coverage for specific services, procedures, or treatments before they are provided. This step helps ensure that the planned care aligns with evidence-based guidelines and medical necessity criteria.
2. Concurrent review: An ongoing evaluation of a patient's treatment during their hospital stay or course of therapy to determine if the services remain medically necessary and consistent with established clinical pathways.
3. Retrospective review: A retrospective analysis of healthcare services already provided to assess their medical necessity, appropriateness, and quality. This step may lead to adjustments in reimbursement or require the provider to justify the rendered services.

Utilization review is typically conducted by a team of healthcare professionals, including physicians, nurses, and case managers, who apply their clinical expertise and adhere to established criteria and guidelines. The process aims to promote high-quality care, reduce wasteful spending, and safeguard patients from potential harm caused by inappropriate or unnecessary treatments.

Concurrent review in a medical context refers to the process of evaluating a patient's treatment plan or care while it is still ongoing, as opposed to a retrospective review that takes place after the fact. The goal of concurrent review is to ensure that the care being provided is appropriate, necessary, and evidence-based, and to identify any potential issues or concerns that may arise during the course of treatment.

Concurrent review is often used in the context of utilization management, where it can help to prevent unnecessary or excessive use of healthcare resources. It may involve reviewing a patient's medical records, laboratory results, and other relevant data to assess the appropriateness of diagnostic tests, medications, and other treatments. The findings of the concurrent review can then be used to inform clinical decision-making and ensure that the patient receives the most effective and efficient care possible.

Concurrent review is typically carried out by a team of healthcare professionals, including physicians, nurses, and other specialists, who work together to evaluate the patient's care and make recommendations for improvement. The process is designed to be collaborative and transparent, with the goal of promoting high-quality care and improving patient outcomes.

A Drug Utilization Review (DUR) is a systematic retrospective examination of a patient's current and past use of medications to identify medication-related problems, such as adverse drug reactions, interactions, inappropriate dosages, duplicate therapy, and noncompliance with the treatment plan. The goal of DUR is to optimize medication therapy, improve patient outcomes, reduce healthcare costs, and promote safe and effective use of medications.

DUR is typically conducted by pharmacists, physicians, or other healthcare professionals who review medication records, laboratory results, and clinical data to identify potential issues and make recommendations for changes in medication therapy. DUR may be performed manually or using automated software tools that can analyze large datasets of medication claims and electronic health records.

DUR is an important component of medication management programs in various settings, including hospitals, long-term care facilities, managed care organizations, and ambulatory care clinics. It helps ensure that patients receive the right medications at the right doses for the right indications, and reduces the risk of medication errors and adverse drug events.

Hospitalization Insurance is a type of health insurance that provides coverage for the expenses incurred during a hospital stay, including surgery, diagnostic tests, doctor's visits, and other related services. This type of insurance may also cover the cost of hospital room and board, intensive care unit (ICU) stays, and nursing services. Some policies may also provide coverage for ambulance transportation, home health care, and rehabilitation services following a hospital stay. The specific benefits and coverage limits will vary depending on the policy and insurance provider.

Health services misuse is not a term that has a specific medical definition. However, it generally refers to the inappropriate or unnecessary use of health services, resources, or treatments. This can include overutilization, underutilization, or incorrect utilization of healthcare services. Examples may include ordering unnecessary tests or procedures, using emergency department services for non-urgent conditions, or failing to seek timely and appropriate medical care when needed. Health services misuse can result in harm to patients, increased healthcare costs, and decreased efficiency in the delivery of healthcare services.

I'm sorry for any confusion, but "Utah" is not a medical term or concept. It is a geographical location, being the 45th state admitted to the United States of America. If you have any questions related to medical topics, I would be happy to try and help answer those for you!

Managed care programs are a type of health insurance plan that aims to control healthcare costs and improve the quality of care by managing the utilization of healthcare services. They do this by using a network of healthcare providers who have agreed to provide services at reduced rates, and by implementing various strategies such as utilization review, case management, and preventive care.

In managed care programs, there is usually a primary care physician (PCP) who acts as the patient's main doctor and coordinates their care within the network of providers. Patients may need a referral from their PCP to see specialists or access certain services. Managed care programs can take various forms, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point-of-Service (POS) plans, and Exclusive Provider Organizations (EPOs).

The goal of managed care programs is to provide cost-effective healthcare services while maintaining or improving the quality of care. They can help patients save money on healthcare costs by providing coverage for a range of services at lower rates than traditional fee-for-service plans, but they may also limit patient choice and require prior authorization for certain procedures or treatments.

Regional health planning is a process that involves the systematic assessment, analysis, and prioritization of healthcare needs for a defined geographic population in a specific region. It aims to develop and implement strategies, programs, and services to address those needs in a coordinated and efficient manner. This collaborative approach often involves various stakeholders, such as healthcare providers, public health officials, community leaders, and advocates, working together to improve the overall health and well-being of the population in that region.

The medical definition of 'Regional Health Planning' can be outlined as follows:

1. Systematic assessment: A comprehensive evaluation of the healthcare needs, resources, and infrastructure within a specific region, taking into account demographic, epidemiological, and socioeconomic factors that influence health outcomes.
2. Analysis: The examination of data and information gathered during the assessment to identify gaps, priorities, and opportunities for improvement in healthcare services and delivery.
3. Prioritization: The process of ranking healthcare needs and issues based on their urgency, impact, and feasibility of intervention, to ensure that resources are allocated effectively and efficiently.
4. Strategy development: The creation of evidence-based, data-driven plans and interventions aimed at addressing the prioritized health needs and improving the overall health of the regional population.
5. Collaboration: The active engagement and partnership of various stakeholders, including healthcare providers, public health officials, community leaders, and advocates, in the planning, implementation, and evaluation of regional health initiatives.
6. Coordination: The alignment and integration of healthcare services, programs, and policies across different levels and sectors to ensure seamless care and avoid duplication of efforts.
7. Continuous improvement: The ongoing monitoring and evaluation of regional health programs and interventions to assess their effectiveness, make adjustments as needed, and incorporate new evidence and best practices into future planning efforts.

An insurance claim review is the process conducted by an insurance company to evaluate a claim made by a policyholder for coverage of a loss or expense. This evaluation typically involves examining the details of the claim, assessing the damages or injuries incurred, verifying the coverage provided by the policy, and determining the appropriate amount of benefits to be paid. The insurance claim review may also include investigating the circumstances surrounding the claim to ensure its validity and confirming that it complies with the terms and conditions of the insurance policy.

A hospital is a healthcare facility where patients receive medical treatment, diagnosis, and care for various health conditions, injuries, or diseases. It is typically staffed with medical professionals such as doctors, nurses, and other healthcare workers who provide round-the-clock medical services. Hospitals may offer inpatient (overnight) stays or outpatient (same-day) services, depending on the nature of the treatment required. They are equipped with various medical facilities like operating rooms, diagnostic equipment, intensive care units (ICUs), and emergency departments to handle a wide range of medical situations. Hospitals may specialize in specific areas of medicine, such as pediatrics, geriatrics, oncology, or trauma care.

Health services research (HSR) is a multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to healthcare, the quality and cost of care, and ultimately, our health and well-being. The goal of HSR is to inform policy and practice, improve system performance, and enhance the health and well-being of individuals and communities. It involves the use of various research methods, including epidemiology, biostatistics, economics, sociology, management science, political science, and psychology, to answer questions about the healthcare system and how it can be improved.

Examples of HSR topics include:

* Evaluating the effectiveness and cost-effectiveness of different healthcare interventions and technologies
* Studying patient-centered care and patient experiences with the healthcare system
* Examining healthcare workforce issues, such as shortages of primary care providers or the impact of nurse-to-patient ratios on patient outcomes
* Investigating the impact of health insurance design and financing systems on access to care and health disparities
* Analyzing the organization and delivery of healthcare services in different settings, such as hospitals, clinics, and long-term care facilities
* Identifying best practices for improving healthcare quality and safety, reducing medical errors, and eliminating wasteful or unnecessary care.

"Length of Stay" (LOS) is a term commonly used in healthcare to refer to the amount of time a patient spends receiving care in a hospital, clinic, or other healthcare facility. It is typically measured in hours, days, or weeks and can be used as a metric for various purposes such as resource planning, quality assessment, and reimbursement. The length of stay can vary depending on the type of illness or injury, the severity of the condition, the patient's response to treatment, and other factors. It is an important consideration in healthcare management and can have significant implications for both patients and providers.

I'm sorry for any confusion, but "United States" is a geopolitical entity, specifically the name of the country consisting of 50 states, and it is not a medical term or concept. Therefore, I can't provide a medical definition for it. If you have any questions related to health, medicine, or biology, I would be happy to try to help answer those!

Thus, this review seems expensive and time-consuming. Retrospective drug utilization review refers to drug therapy review that ... Drug utilization review helps pharmacists to evaluating the medication for patients. Drug utilization review plays a key role ... Drug use/ utilization evaluation and medication utilization evaluations are the same as drug utilization review. With the ... The first document published related to drug utilization review was in 1969. Drug utilization review acted as a background ...
... (UM) or utilization review is the use of managed care techniques such as prior authorization that allow ... "Understanding Independent Medical Review and Utilization Review Services" (PDF). NAIRO. "Technical Release No. 2011-02". United ... As of 2018, in 42 states IROs must be accredited by the utilization review education and standards nonprofit URAC. Notable IRO ... Findings from a 2019 systematic review identified how guidelines for UM are often more focused on reduction of utilization than ...
"WOOD BIOMASS UTILIZATION AND CONSEQUENCE ENVIRONMENTAL CHALLENGES IN NIGERIA- A REVIEW". 2019 Boston, Massachusetts July 7- ... Fuel wood utilization in Nigeria (alternately, firewood utilization in Nigeria) is a traditional source of energy for domestic ... A review of the potential". Renewable and Sustainable Energy Reviews. 22: 257-268. doi:10.1016/j.rser.2013.01.020. ISSN 1364- ... Fuel wood utilization contributes to climate change through the release of carbon emissions into the atmosphere. When fuel wood ...
A critical review on current system developments and biomass utilization". Critical Reviews in Environmental Science and ... "Analytical Review of Life‐Cycle Environmental Impacts of Carbon Capture and Utilization Technologies". ChemSusChem. 14 (4): 995 ... "Environmental impacts of carbon capture and utilization by mineral carbonation: A systematic literature review and meta life ... Carbon capture and utilization (CCU) is defined as capturing CO2 from industrial processes and transporting it via pipelines to ...
... this is also referred to as drug utilization review (DUR). The DUR process is completed by the pharmacist. The process reviews ... "Drug Utilization Review , AMCP.org". www.amcp.org. Retrieved 2021-01-15. "The Community Pharmacist as a Provider of ... A retrospective DUR reviews drug therapy after the drug therapy is completed. The retrospective review helps detect patterns in ... Prospective DUR review is when a patient's planned drug therapy is evaluated before a medication is dispensed. Concurrent ...
... drug-utilization review; formulary management; and medical and drug data analysis services to manage drug plans for health ... the Express Scripts Drug Trend Report provides detailed analysis of prescription drug costs and utilization. Now a web-based ...
May 2000). "How is mechanical ventilation employed in the intensive care unit? An international utilization review". American ... The Cochrane Database of Systematic Reviews. 2021 (3): CD013732. doi:10.1002/14651858.CD013732.pub2. PMC 8121090. PMID 33729556 ...
An international utilization review". Am J Respir Crit Care Med. 161 (5): 1450-8. doi:10.1164/ajrccm.161.5.9902018. PMID ... The Cochrane Database of Systematic Reviews. 2017 (7): CD004104. doi:10.1002/14651858.CD004104.pub4. hdl:10044/1/53458. PMC ...
An international utilization review". American Journal of Respiratory and Critical Care Medicine. 161 (5): 1450-8. doi:10.1164/ ... A 2013 systematic review calculated procedural mortality to be 0.17% or 1 in 600 cases. Multiple systematic reviews identified ... A 2016 systematic review identified a higher rate of tracheal stenosis in individuals who underwent a surgical tracheostomy, as ... A 2013 systematic review (published cases from 1985 to April 2013) studied the complications and risk factors of percutaneous ...
Carol H. Weiss (October 1979). "The Many Meanings of Research Utilization". Public Administration Review. 39 (5): 426-431. doi: ... " "The many meanings of research utilization", Public administration review (1979) Evaluation: Methods for Studying Programs ...
"Off-label Use of Gabapentin" (PDF). Idaho Drug Utilization Review, educational leaflet. 2004. Archived from the original (PDF) ...
HMOs also manage care through utilization review. That means they monitor doctors to see if they are performing more services ... A possible reason for this failure is that consumers might increase utilization in response to less cost sharing under HMOs. ...
Dobbins, R; Cockerill, R; Barnsley, J (2001). "Factors Affecting the Utilization of Systematic Reviews". International Journal ... Meta-reviews have identified several characteristics that are common among most studies. These are in line with the ... McPherson, M; Smith-Lovin, L; Cook, JM (2001). "Birds of a Feather: Homophily in Social Networks". Annual Review of Sociology. ... Katz, E; Levin, M; Hamilton, H (1963). "Traditions of Research on the Diffusion of Innovation". American Sociological Review. ...
... utilization management and utilization review. These techniques can be applied to both network-based benefit programs and ... A 2008 systematic review found consistent evidence that health insurance increased utilization of services and improved health ... Formal utilization review and quality improvement programs; An emphasis on preventive care; and Financial incentives to ... The two primary HMO trade associations were the Group Health Association of America and the American Managed Care and Review ...
Falcao, A.F.de O. (2010). "Wave energy utilization: A review of the technologies". Renewable Energy and Sustainable Energy ... "Energy and the Environment, A Coastal Perspective". Heath, T.V. (2012). "A Review of Oscillating Water Columns" (PDF). ...
Falcão, António F. de O. (April 1, 2010). "Wave energy utilization: A review of the technologies". Renewable and Sustainable ... A review". Renewable and Sustainable Energy Reviews. 82: 3263-3278. doi:10.1016/j.rser.2017.10.018. Felix, Angélica; V. ... Falnes, J. (2007). "A review of wave-energy extraction". Marine Structures. 20 (4): 185-201. doi:10.1016/j.marstruc.2007.09.001 ... Aderinto, Tunde and Li, Hua (2019). "Review on power performance and efficiency of wave energy converters". Energies. 12 (22): ...
McNutt, Josiah; He, Quan (Sophia) (March 2019). "Spent coffee grounds: A review on current utilization". Journal of Industrial ... A review on current research and future prospects". Trends in Food Science & Technology. 45 (1): 24-36. doi:10.1016/j.tifs. ... A Narrative Review". Agronomy. 12 (11): 2771. doi:10.3390/agronomy12112771. ISSN 2073-4395. Mussatto, Solange I.; Carneiro, ... "Sustainable management of coffee industry by-products and value addition-A review". Resources, Conservation and Recycling. 66: ...
Wagner, G.M. (1997). "Azolla: a review of its biology and utilization". Bot. Rev. 63: 1-26. doi:10.1007/BF02857915. S2CID ... Use of algae and aquatic macrophytes as feed in small-scale aquaculture: A review. FAO Fisheries and Aquaculture technical ... Evrard, C.; Van Hove, C. (2004). "Taxonomy of the American Azolla species (Azollaceae): A critical review". Systematics and ... Agnihotri, Vijai K. (2014). "Anabaena flos-aquae". Critical Reviews in Environmental Science and Technology. 44 (18): 1995-2037 ...
From traditional utilization to modern therapeutics-A review". Phytotherapy Research. 35 (4): 1847-1871. doi:10.1002/ptr.6924. ... From traditional utilization to modern therapeutics-A review". Phytotherapy Research. 35 (4): 1847-1871. doi:10.1002/ptr.6924. ... From traditional utilization to modern therapeutics-A review". Phytotherapy Research. 35 (4): 1847-1871. doi:10.1002/ptr.6924. ...
Wave power Falcão, António F. de O. (2009). "Wave energy utilization: A review of the technologies". Renewable and Sustainable ... Energy Reviews. 14 (3): 899-918. doi:10.1016/j.rser.2009.11.003. "The Masuda Device". daedalus.gr. Archived from the original ...
doi:10.1016/S0166-1280(03)00348-8. Wilson, Philip J.; Wells, Joseph H. (1944-02-01). "The Chemistry and Utilization of ... Chemical Reviews. 121 (12): 6777-6801. doi:10.1021/acs.chemrev.0c01055. PMC 8222071. PMID 33651602. Roberts, John D.; Sharts, ... Cyclopentadiene". Chemical Reviews. 34 (1): 1-50. doi:10.1021/cr60107a001. ISSN 0009-2665. Lenz, Terry G.; Vaughan, John D. ( ...
"Interventions to promote patient utilisation of cardiac rehabilitation". The Cochrane Database of Systematic Reviews. 2 (2): ... "Interventions to promote patient utilisation of cardiac rehabilitation". The Cochrane Database of Systematic Reviews. 2 (2): ... There are specific reviews on benefits of CR in patients with specific health conditions such as valve issues, atrial ... January 2022). "A Review of the Design and Implementation of a Hybrid Cardiac Rehabilitation Program: AN EXPANDING OPPORTUNITY ...
Utilization and Health of Urban Forests: A Review". Notulae Botanicae Horti Agrobotanici Cluj-Napoca. 47 (1): 10-16. doi: ... Key features of the law include the formation of a Tree Working Group, which reviews tree-related policies, and a Tree Review ... After thorough review, computer-based and paper exams can be taken to officially earn a certain credential. As urban forestry ... Urban wood utilization is an often overlooked provisioning service. Almost 70% of urban wood is wasted while only 25% is ...
Ghaly, Abdelkader (July 2021). "Greywater Sources, Characteristics, Utilization and Management Guidelines: a review". Research ...
"Civil Law Notary: An Office Whose Time Has Come?" (PDF). "Understanding Independent Medical Review and Utilization Review ... L Bebchuk, 'The Case for Increasing Shareholder Power' (2004-5) 118 Harvard Law Review 833, 844 "2000 ABA Model Procurement ... The National Association of Insurance Commissioners's issued the Uniform Health Carrier External Review Model Act. The 2010 ... by Stanley Kurtz-National Review education writer and Senior Fellow at the Ethics and Public Policy Center-to limit the ...
Milliken, W. (1998). "Review of Medicinal Plants: Can utilization and conservation coexist? by Jennie Wood Shelton, Michael J. ... The Quarterly Review of Biology. 71 (4): 572. doi:10.1086/419583. Knelman, Fred H. (2000). "Reviewed work: Plants, People and ... Marderosian, Ara der (1996). "Review of Plants, People, and Culture: The Science of Ethnobotany by Michael J. Balick and Paul ... Schultes, Richard Evans (1993). "Review of The Subsidy from Nature by Anthony B. Anderson, Peter H. May & Michael J. Balick". ...
"Bed Utilisation Review (BUR) Project" (PDF). South Tees Clinical Commissioning Group. Retrieved 28 June 2015. "Medworxx Patient ... Medworxx Patient Flow systems were used by South Tees Hospitals NHS Foundation Trust in a Bed Utilisation Review Project in ... Medworxx is one of two companies in the UK offering embedded solutions[buzzword] for utilisation review, the other being the ... Retrieved 28 June 2015.[permanent dead link] "Utilisation review A scoping study" (PDF). West Midlands Clinical Senate. October ...
How to use an article about a clinical utilization review. Evidence-Based Medicine Working Group. JAMA, 275(18), pp. 1435-1439 ...
2 1977 (Great Britain). C.F. Muller, Review of Twenty Years of Research on Medical Care Utilization, Health Services Research, ... Muller, C (June 1986). "Review of twenty years of research on medical care utilization". Health Services Research. 21 (2 Pt 1 ... ISBN 978-0-87154-610-4. Health Care Financing Review. Department of Health, Education, and Welfare, Health Care Financing ...
doi:10.1061/(ASCE)0733-950X(1995)121:4(224). Polemio, Maurizio; Zuffianò, Livia Emanuela (2020). "Review of Utilization ... A Review of a Regional Experience". Water. 8 (4): 148. doi:10.3390/w8040148. Polemio, Maurizio; Pambuku, Arben; Limoni, Pier ...
Thus, this review seems expensive and time-consuming. Retrospective drug utilization review refers to drug therapy review that ... Drug utilization review helps pharmacists to evaluating the medication for patients. Drug utilization review plays a key role ... Drug use/ utilization evaluation and medication utilization evaluations are the same as drug utilization review. With the ... The first document published related to drug utilization review was in 1969. Drug utilization review acted as a background ...
The Clinical Utilization Review Board (CURB) is recruiting for three positions. Per statute, CURB should be comprised of ... dvha.vermont.gov/advisory-boards/clinical-utilization-review-board.. If participating in the work of CURB is of interest, ...
Utilization review and management.. A. The MCHIP licensee shall have a utilization review and management process that complies ... B. In developing its utilization review program, the MCHIP licensee shall utilize the applicable utilization review and ... or for utilization review entities such as private review agents licensed in Virginia, to which MCHIPs may delegate utilization ... A description of the organizational responsibilities for utilization review including the qualifications of utilization review ...
"Drug Utilization Review" by people in Harvard Catalyst Profiles by year, and whether "Drug Utilization Review" was a major or ... Drug utilization review may consider clinical appropriateness, cost effectiveness, and, in some cases, outcomes. Review is ... "Drug Utilization Review" is a descriptor in the National Library of Medicines controlled vocabulary thesaurus, MeSH (Medical ... Impact of a nationwide prospective drug utilization review program to improve prescribing safety of potentially inappropriate ...
Improved understanding of determinants of health service utilization can support health service access for people with CP. ... CP health service utilization is associated with age, severity and comorbidities. ... Determinants of Hospital-Based Health Service Utilization in Cerebral Palsy: a Systematic Review Arch Phys Med Rehabil. 2022 ... To systematically review and synthesize evidence of determinants associated with hospital-based health service utilization ...
As more biopharma companies create or expand the role of a promotion review editor, this report probes collaboration approaches ... Responsibilities in Review Process and Time Spent. *Responsibilities of Promotion Review Editor in review process - Total ... Responsibilities lead and supported by Promotion Review Editor in review process *Time spent in Promotion Review Editor role * ... Involvement of Promotion Review Editor in electronic submissions; Review of promotional materials by Promotion Review Editor ...
An Integrative Review of the Utilization of the Perceived Stress Scale in Stroke Recovery ... Systematic reviews and meta-analyses were excluded. Evidence was synthesized, and themes were discussed. RESULTS: Among 397 ... OBJECTIVE: The aim of this study was to describe the utilization of the Perceived Stress Scale (PSS) during recovery in SS. ...
Our utilization management (UM) aftercare services help your Tufts Health Plan patients receive the care and services they need ... Utilization Management Review (Care Coordination). Tufts Health Public Plans. Our utilization management (UM) aftercare ... Provider / Tufts Health Public Plans /Our Programs + Services: Utilization Management Review (Care Coordination) ... Our utilization care managers work to:. *Identify and provide appropriate care coordination to your Tufts Health Plan patients ...
... ... Statistical Trends In Utilization Review In Extended Care Facilities After 3 Years Of Medicare ... Kleffel, D "Statistical Trends In Utilization Review In Extended Care Facilities After 3 Years Of Medicare" 88, no. 3 (1973). ... Kleffel, D (1973). Statistical Trends In Utilization Review In Extended Care Facilities After 3 Years Of Medicare. 88(3). ...
Atlantic Coast Diadromous Fish Habitat: A Review of Utilization, Threats, Recommendations for Conservation, and Research Needs ...
The paper also concludes that in the classes the technology-utilization level of viola teachers is the highest; cello and ... Research data has been collected via literature review and questionnaire developed and prepared by the researcher. SPSS program ... instrument teachers make use of computers at the intermediate level and have adequate knowledge on its area of utilization in ... The purpose of this study is to determine the technology-utilization level of Fine Arts High School string instrument teachers ...
b,Reviews,/b,,br,,br,Review on Sisal Waste Utilisation : Challenges and Opportunities ... Utilisation of sisal waste for mushroom growing, animal feed and productionof biogas has already been demonstrated at pilot ... This holistic approach tothe utilisation of the sisal plant, presents the only hope and future to this ailing industry. By ...
Utilization Review for Injured City of Chicago Workers - Chicago Workers Compensation Lawyer ... Techniques for utilization review can include second opinions, concurrent review, peer review, discharge planning, independent ... Different kinds of utilization review may be used for current, past, or proposed future care. A current review will look at ... Scope of Review. Once the utilization review process is invoked and written notice is received, medical providers are supposed ...
In 2021, the defendant stopped paying for treatment, following their utilization review. Defendants utilization review ... At its core, a utilization review is an initial evaluation of the appropriateness of the level and quality of treatment. The ... COA: Insurance Code Does Not Require Administrative Appeal as a Precondition to Sue Insurance Company Over Utilization Reviews ... They then issued an explanation of benefits (EOB) denying plaintiff payment based on its utilization review. ...
Annual reviews of physical health are not associated with risk of unplanned hospital utilisation. ... Do care plans and annual reviews of physical health influence unplanned hospital utilisation for people with serious mental ... 13 more authors) (2018) Do care plans and annual reviews of physical health influence unplanned hospital utilisation for people ... care plans and annual reviews of physical health) and the hazards of three types of unplanned hospital utilisation: ...
Find out how they are reviewed on the Blue Cross MedicareRx plan. ... Drug Utilization Review. Blue Cross MedicareRx conducts drug ... The review is done each time you fill a prescription, as well as on a regular basis. We look for issues such as:. *Medication ... utilization reviews that help make sure youre getting safe and proper care. They are very important if you have more than one ... If we find a problem during the review, well work with your doctor to fix it. ...
Information, Decisions, and Productivity: On Board Computers and Capacity Utilization in Trucking. American Economic Review. 93 ... Information, Decisions, and Productivity: On Board Computers and Capacity Utilization in Trucking, American Economic Review ... Information, Decisions, and Productivity: On Board Computers and Capacity Utilization in Trucking. American Economic Review. 93 ... Review Courses & Schedules Access information about specific courses and their schedules by viewing the interactive course ...
A total of 137 papers were selected, based upon including information about chiropractic utilization, CAM utilization and low ... Studies looking at chiropractic utilization demonstrate that the rates vary, but generally fall into a range from around 6% to ... Utilization Rate; Use Rate; Complementary and Alternative Medicine; and Health Services in various combinations. ... To conduct a descriptive review of the scientific literature examining use rates of modalities and procedures used by CAM ...
Utilization Review. Historically, third-party payers tended to concentrate their cost containment energies on the unit price of ... FMCs pioneered many utilization review tools, including model treatment profiles to assess physician performance, protocols for ... and quality and utilization review of health care services (see Chapter 6 for a discussion of these programs). With the ... the first explicit use of retrospective utilization review to control fee-for-service payments for unnecessary and ...
Although there are several published single-centre AED utilisation studies,34-36 these have not been included in this review ... Carbamazepine utilisation was high in Hong Kong and Singapore, but low in Taiwan. The utilisation of oxcarbazepine, which is ... Objectives This study aims to determine global anti-epileptic drug (AED) utilisation prevalence and describe utilisation trends ... 33 Many of the studies in this review are old and may not be reflective of the current utilisation rates in the respective ...
Provide daily updates to Manager of Utilization Management for review. Skills and Qualifications: *Bachelors degree in Nursing ... Utilization Review Registered Nurse (RN) Fully remote. Columbus, OH. Apply Now. About us:. Morgan Stephens represents the ... Concurrent review of patients clinical information for efficiency. *Ongoing review of precertification requests for medical ... Utilization management nurses role is to ensure that health care services are administered with quality, cost efficiency, and ...
Prospective Reviews. Retrospective Reviews. Concurrent Reviews. Physician Component Only (PCO). Pharmacy/Drug Utilization ... Peer Review/Physician Advisor. Drug Regimen Reviews. CPT/HCPCS/NDC, NDC Reviews. ICD-9/ICD-10 Code/Billing Reviews. Diagnostic ... ENHANCE YOUR UTILIZATION MANAGEMENT. Client-driven utilization review solutions help you get better results, faster. ... Every aspect of our platform has been honed for efficiency, sustained by our state-of-the-art utilization review portal. Our ...
Understanding the utilization of primary health care services by Indigenous men : A systematic review. In: BMC Public Health. ... Understanding the utilization of primary health care services by Indigenous men : A systematic review. / Canuto, Kootsy; Brown ... This review aims to better understand the utilization of primary health care services by Indigenous men and assess the ... This review aims to better understand the utilization of primary health care services by Indigenous men and assess the ...
Healthcare Utilization and Finance (Western Governor University). The graduate analyzes financial implications related to ... Answered) Healthcare Utilization and Finance Healthcare Utilization and Finance (Western Governor University). The graduate ...
... degree of care that a physician reviewer of ordinary prudence making utilization review determinations for a utilization review ... 1b.Utilization review.. The board may investigate allegations and impose disciplinary action as described in section 147.141 ... the board shall receive consultation or recommendation from physicians who are currently engaged in utilization review ... The internal and external review processes under sections 62M.06 and 62Q.73 must be exhausted prior to an allegation being ...
Effectiveness of maternity waiting homes in increasing utilization of facility-based delivery : A systematic review. In: ... Effectiveness of maternity waiting homes in increasing utilization of facility-based delivery: A systematic review. ... Effectiveness of maternity waiting homes in increasing utilization of facility-based delivery: A systematic review. / Secka, ... title = "Effectiveness of maternity waiting homes in increasing utilization of facility-based delivery: A systematic review", ...
The minimum qualifications for a career as a Utilization Reviewer include an undergraduate degree and two years of experience ... How To Become A Utilization Review Specialist?. Review 26.05.2023. The minimum qualifications for a career as a Utilization ... How much does utilization review pay in Louisiana?. As of May 12, 2023, the average annual pay for the Utilization Review jobs ... How much does utilization review pay in Colorado?. How much does an Utilization Review Nurse make in Colorado? As of May 3, ...
... B.K. Sarkar1*, S. Upadhyay2, P. Gogoi2, A. Datta3, Z. Rahman4 and S. ... Utilization of Spent Hen Meat for Soup: A Review.Int.J.Curr.Microbiol.App.Sci. 8(2): 2702-2709. doi: https://doi.org/10.20546/ ... Editorial Review Policy Embargo Policy Ethical Expectations Consent For Identifying Information Informed Consent Manuscript ... Withdrawal Policy Peer Review Process Plagiarism Policy Ethical Violations Appeal Policy Against Editorial Decision Advertising ...
Utilization review. *Step therapy. *Care process models. *High-dollar auditing. Care and utilization management is part of the ... Use Care and Utilization Management. Better Health and Lower Cost. Every Select Health plan includes care and utilization ...
  • On May 25, 2023, the Michigan Court of Appeals issued a decision in True Care Physical Therapy v. Auto Club Group Insurance Company (COA Docket No. 362094), an auto no-fault case that involved a health care provider who filed suit against an auto insurance company rather than first appeal the insurer's utilization review determination to the Michigan Department of Insurance and Financial Services (DIFS). (chiromi.com)
  • In this systematic review, AED prescriptions in different countries were identified from the published literature. (bmj.com)
  • This systematic review, therefore, aims to assess the effectiveness of the Maternity waiting home strategy in increasing utilization of facility delivery. (unair.ac.id)
  • Li M, Xiang L, Li Y. Efficacy and safety of compound glycyrrhizin in the patients with vitiligo: a systematic review and meta-analysis. (medscape.com)
  • We conducted a systematic review of the PubMed and Google Scholar databases, and we calculated medicine utilization in Bulgaria during 2018 and 2019 using the WHO methodology. (jphres.org)
  • The registration needs to certify compliance with the Workers' Compensation Utilization Management Standards of the Utilization Review Accreditation Commission (URAC) or submit other evidence of URAC accreditation. (kfeej.com)
  • Some companies seek candidates with certification through an organization like the Utilization Review Accreditation Commission (URAC). (rubyradio.fm)
  • C. The MCHIP licensee, or its contracted private review agent or other delegated service entity for utilization review and management services, may demonstrate compliance with the utilization management and review requirements of this section by attaining accreditation or certification with the American Accreditation HealthCare Commission/URAC, the National Committee for Quality Assurance, or other nationally recognized accrediting body with comparable standards for utilization review accepted by the department. (virginia.gov)
  • According to the COA, Michigan's revised auto no-fault insurance statute does not require a medical provider to administratively appeal an insurance company's utilization review. (chiromi.com)
  • External Review - When an independent review organization is consulted to appeal an insurance company's adverse determination. (harborcompliance.com)
  • In community pharmacy Settings, Federal Law (OBRA-90) requires drug utilization review for patients receiving medication through Medicaid. (wikipedia.org)
  • Recognizing that Medicaid recipients faced similar risks in the 1980s, Congress provided for the ambulatory drug utilization review under the Omnibus Budget Reconciliation Act of 1990. (wikipedia.org)
  • Drug utilization review is mandated for Medicaid programs beginning in 1993. (harvard.edu)
  • This review aims to better understand the utilization of primary health care services by Indigenous men and assess the effectiveness of strategies implemented to improve utilization. (edu.au)
  • 8. Participates in analyzing, updating, and modifying procedures and processes to continually improve utilization review operations. (bilh.org)
  • D. An MCHIP licensee that is not accredited by a nationally recognized accrediting body and accepted by the department shall be subject to the triennial comprehensive onsite examination requirements of 12VAC5-408-90 for purposes of demonstrating compliance with the utilization review and management requirements of this section. (virginia.gov)
  • Utilization management nurses role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. (catsone.com)
  • Harbor Compliance is not acting as your attorney and does not review information you provide to us for legal accuracy or sufficiency. (harborcompliance.com)
  • Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. (remotenursingjobs.com)
  • Blue Cross MedicareRx conducts drug utilization reviews that help make sure you're getting safe and proper care. (bcbsnm.com)
  • Utilization Review Agent (URA) - An entity that conducts utilization review. (harborcompliance.com)
  • Conducts primary functions of prior authorization, inpatient review, concurrent review, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. (remotenursingjobs.com)
  • Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review of medical records to ensure criteria for admission and continued stay are met and documented. (bilh.org)
  • To make this evaluation, the City of Chicago uses a system that relies on standards of care as set forth in nationally recognized treatment and peer review guidelines. (kfeej.com)
  • With so many new options for medical and utilization review services, it's important to be selective when choosing a medical peer review provider. (concentra.com)
  • The report highlights effective collaboration approaches, roles and responsibilities, and provides insights into importance and effectiveness of Promotion Review Editor within the company to streamline the review process and boost productivity. (best-in-class.com)
  • The Utilization Review Specialist Senior responsibilities include: Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services Perform other duties as assigned by the supervisor including but not limited to processing concurrent denials. (experiencedalliedhealth.com)
  • Applicable utilization review and management standards are those included in an accreditation or certification program for a specific type of MCHIP, such as health maintenance organizations or preferred provider organizations, or for utilization review entities such as private review agents licensed in Virginia, to which MCHIPs may delegate utilization review and management services. (virginia.gov)
  • Select Health cost analysis of utilization management savings from 2018. (selecthealth.org)
  • The minimum qualifications for a career as a Utilization Reviewer include an undergraduate degree and two years of experience in the review area of focus. (rubyradio.fm)
  • Review is usually retrospective, but some analysis may be done before drugs are dispensed (as in computer systems which advise physicians when prescriptions are entered). (harvard.edu)
  • A retrospective review will evaluate a past decision based on the medical information a treating doctor had at the time any treatment decisions were made. (kfeej.com)
  • Retrospective Review - Utilization review that occurs after treatment and often after payment. (harborcompliance.com)
  • 1, Performs a variety of concurrent and retrospective utilization management-related reviews and functions to ensure that appropriate data are tracked, evaluated, and reported. (bilh.org)
  • 5. Maintains current knowledge of hospital utilization review processes and participates in the resolution of retrospective reimbursement issues, including appeals, third-party payer certification, and denied cases. (bilh.org)
  • High adherence to the 'Wise List' treatment recommendations in Stockholm: a 15-year retrospective review of a multifaceted approach promoting rational use of medicines. (janusinfo.se)
  • Observational studies were included that described people with CP, reported quantitative measures of hospital-based health service utilization (inpatient, outpatient, emergency department), and based in high-income countries. (nih.gov)
  • Increased health service utilization was associated with "individual need" including severe gross motor disability, epilepsy, developmental/ intellectual disability and gastrostomy-use across inpatient, outpatient and emergency department settings. (nih.gov)
  • Healthcare Utilization and Finance (Western Governor University). (customwritingreviews.com)
  • Schmidt-Mende K, Andersen M, Wettermark B, Hasselström J. Educational intervention on medication reviews aiming to reduce acute healthcare consumption in elderly patients with potentially inappropriate medicines -A pragmatic open-label cluster randomized controlled trial in primary care. (janusinfo.se)
  • Objectives This study aims to determine global anti-epileptic drug (AED) utilisation prevalence and describe utilisation trends in different countries. (bmj.com)
  • Despite the broad spectrum of PD manifestations and high disease prevalence, there are insufficient data on medicine utilization and prescription strategies. (jphres.org)
  • Methods Databases Embase (1980-May 2017), Medline (1946-May 2017) and PubMed were searched for original research on AED utilisation. (bmj.com)
  • Methods: A four-step search strategy was employed across four databases to find peer-reviewed publications and grey literature from Australia, New Zealand, Canada and America. (edu.au)
  • Demonstrates expertise in the utilization management principles, methods, and tools and incorporates them into the daily operations of the organization. (bilh.org)
  • Applies the principles and methods necessary to perform utilization management functions. (bilh.org)
  • Competency in applying the principles, methods, materials, and equipment necessary in providing utilization management services. (bilh.org)
  • This article reviews the technical aspects of coal mine methane (CMM) capture in and from coal mines, the factors affecting CMM accumulations in underground coal mines, methods for capturing methane using boreholes, and borehole designs. (cdc.gov)
  • An employer or insurer can challenge your request for medical services through a utilization review. (kfeej.com)
  • The City of Chicago, like other employers, is entitled to conduct a utilization review of an employee's medical care to determine whether the degree and quality of the services they are receiving is proper. (kfeej.com)
  • OBJECTIVE: To investigate whether two primary care activities that are framed as indicators of primary care quality (comprehensive care plans and annual reviews of physical health) influence unplanned utilisation of hospital services for people with serious mental illness (SMI). (whiterose.ac.uk)
  • Our clinical review services support our clients at every stage of the injured workers' continuum of care to accelerate a rapid recovery and return to work. (nexmc.com)
  • Every Select Health plan includes care and utilization management services that will help you keep employees healthy and reduce unnecessary costs. (selecthealth.org)
  • Utilization Review - A system for evaluating the medical necessity, efficiency, and appropriateness of medical services. (harborcompliance.com)
  • Responsible for utilization management services within the scope of licensure. (remotenursingjobs.com)
  • Reviews provider requests for services requiring authorization. (remotenursingjobs.com)
  • We provide pharmacy reviews, utilization reviews, complex chart reviews, Family Medical Leave Act (FMLA) reviews, disability reviews, ADA accommodation medical reviews , and claims adjudication services in a timely and cost-efficient manner. (concentra.com)
  • Our medical review services not only help payors contain medical costs, but also streamline your utilization review process, provide the medical advisor coverage you need, and help you ensure compliance with the Utilization Review Accreditation Commission (URAC), the Health Insurance Portability and Accountability Act (HIPAA) and jurisdictional requirements. (concentra.com)
  • Factors affecting oral and dental services` utilization among Elderly: a scoping review. (bvsalud.org)
  • This study aimed to identify the factors affecting oral and dental services` utilization among elderly . (bvsalud.org)
  • The published articles on the factors affecting oral and dental services` utilization among elderly were found through a scoping search and using related keywords in PubMed , Scopus, Embase, and Web of Science databases within January 2000 - December 2022 according to the PRISMA guidelines. (bvsalud.org)
  • The factors affecting oral and dental services` utilization among elderly were classified into five main components as follows access, demographic factors, social factors , health level , and mental factors. (bvsalud.org)
  • Equitable utilization of oral and dental services is the right of all members of the society, especially the elderly . (bvsalud.org)
  • This scoping review explores barriers to family planning services utilization and uptake among women in Iraq. (who.int)
  • Valuing a large family is still a barrier to family planning services utilization and uptake whereas religion was found to support the use of family planning. (who.int)
  • This scoping review aimed to examine policy, health system, cultural and social factors that hinder utilization and uptake of FP services among Iraqi women (from both supply and demand sides) to understand the current barriers. (who.int)
  • At its core, a utilization review is an 'initial evaluation' of the appropriateness of the level and quality of treatment. (chiromi.com)
  • handle referrals for specialty care Process incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and complex requests for precertification and/or prior authorization Verify benefits and/or eligibility information. (rubyradio.fm)
  • Prescription prior-authorization policy means that the health plan or state program is required to review a physician's prescription request before coverage for the medication is granted. (cdc.gov)
  • In 2021, the defendant stopped paying for treatment, following their utilization review. (chiromi.com)
  • Complete data last reviewed February 05, 2021. (harborcompliance.com)
  • Determinants of health service utilization were identified and categorized using the Andersen behavioral model. (nih.gov)
  • Then, how to use drug utilization evaluation and drug economy evaluation to improve and optimize the allocation of medical and health resources is a major problem faced by many countries. (wikipedia.org)
  • In the drug utilization review, medicine and health history including all phases of dispensing for a patient is exactly listed. (wikipedia.org)
  • In addition, The World Health Organization (WHO) regards drug utilization as 4 phases of drugs in society. (wikipedia.org)
  • Drug utilization review acted as a background paper written by the United States Department of Health, Education, and Welfare task force. (wikipedia.org)
  • To systematically review and synthesize evidence of determinants associated with hospital-based health service utilization among individuals with cerebral palsy (CP). (nih.gov)
  • CP health service utilization is associated with age, severity and comorbidities. (nih.gov)
  • Improved understanding of determinants of health service utilization can support health service access for people with CP. (nih.gov)
  • Do care plans and annual reviews of physical health influence unplanned hospital utilisation for people with serious mental illness? (whiterose.ac.uk)
  • OUTCOMES AND ANALYSIS: Cox survival models were used to estimate the associations between two primary care quality indicators (care plans and annual reviews of physical health) and the hazards of three types of unplanned hospital utilisation: presentation to accident and emergency departments (A&E), admission for SMI and admission for ambulatory care sensitive conditions (ACSC). (whiterose.ac.uk)
  • Annual reviews of physical health are not associated with risk of unplanned hospital utilisation. (whiterose.ac.uk)
  • Electronic databases, such as administrative health databases, dispensing databases and health insurance records, provide a valuable tool for carrying out utilisation studies. (bmj.com)
  • The search was unable to find published research on strategies implemented to improve primary health care utilization by Indigenous men. (edu.au)
  • There is limited published research focused on the utilization of primary health care by Indigenous men. (edu.au)
  • Care and utilization management is part of the complete care you'll receive with Select Health-these integrated programs saved our employers up to $110 million in avoidable utilization last year. (selecthealth.org)
  • Adverse Determination - When a health care plan or utilization review program decides that a medical treatment or service is not necessary. (harborcompliance.com)
  • Sentara Health Plans is currently hiring Utilization Review Nurse for our Commercial Hospital Review Team! (remotenursingjobs.com)
  • Diversification through medicinal improves the cropping systems, utilization of waste/marginal lands, organic farming, quality of end products, soil health, ecological environmental and economics of cultivation system. (forageresearch.in)
  • This review identifies factors associated with formal health service utilisation for CMD in the general adult population, and compares evidence from high-income countries (HIC) with that from low-and-middle-income countries (LMIC). (maastrichtuniversity.nl)
  • Future research should examine factors associated with health service utilisation for CMD in LMIC, and the effect of health systems and neighbourhood factors. (maastrichtuniversity.nl)
  • and utilization of research in health policy development. (who.int)
  • Risks of hospital admission for SMI were not associated with care plans, and none of the outcomes were associated with annual reviews. (whiterose.ac.uk)
  • 6. Monitors effectiveness/outcomes of the utilization management program, identifying and applying appropriate metrics, supporting the evaluation of the data, reporting results to various audiences, and implementing process improvement projects as needed. (bilh.org)
  • Drug use/ utilization evaluation and medication utilization evaluations are the same as drug utilization review. (wikipedia.org)
  • As an industry leader, Concentra's knowledge, experience, and technology provides reliable evaluations for utilization reviews through an extensive panel of expert medical advisors. (concentra.com)
  • This prospective review is based on the history recording of the drug and medication. (wikipedia.org)
  • Prospective Review - Utilization review that occurs prior to treatment. (harborcompliance.com)
  • Position Summary: In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. (bilh.org)
  • Drug utilization reviews will help ensure that drugs are used appropriately (for individual patients). (wikipedia.org)
  • Drug utilization review refers to a review of prescribing, dispensing, administering and ingesting of medication. (wikipedia.org)
  • Then, especially in the community medicine setting, Drug utilization review plays a key role for pharmacist. (wikipedia.org)
  • Drug utilization review originated from the North America. (wikipedia.org)
  • However, in the recent years, other countries do more research and studies about drug utilization review. (wikipedia.org)
  • Some developments are regarded as important promoters for the appearance of drug utilization review. (wikipedia.org)
  • The first document published related to drug utilization review was in 1969. (wikipedia.org)
  • This task force considered that drug utilization review was potential but this review should be evaluated and need valid evidence to put into effect. (wikipedia.org)
  • In 1970, Drug utilization review program was carried out by a private pharmaceutical management company. (wikipedia.org)
  • By the mid-1970, many medical programs cooperate with private companies that providing drug utilization review. (wikipedia.org)
  • From 1985, hospitals in America are requested to use drug utilization review when using antibiotics. (wikipedia.org)
  • Then Drug utilization review was common in society. (wikipedia.org)
  • It set up three relevant goals for a drug utilization review program. (wikipedia.org)
  • Except goals mentioned above, there are still other goals of drug utilization review. (wikipedia.org)
  • Prospective drug utilization review refers to assessing appropriate drug and decision making therapeutically before patients' medication are dispensed. (wikipedia.org)
  • There are some issues addressed by this review: drug abuse clinically, alteration of drug dosage, drug-drug interaction, and drug-disease interaction. (wikipedia.org)
  • Drug Utilization Review" is a descriptor in the National Library of Medicine's controlled vocabulary thesaurus, MeSH (Medical Subject Headings) . (harvard.edu)
  • This graph shows the total number of publications written about "Drug Utilization Review" by people in Harvard Catalyst Profiles by year, and whether "Drug Utilization Review" was a major or minor topic of these publication. (harvard.edu)
  • Below are the most recent publications written about "Drug Utilization Review" by people in Profiles. (harvard.edu)
  • Impact of a nationwide prospective drug utilization review program to improve prescribing safety of potentially inappropriate medications in older adults: An interrupted time series with segmented regression analysis. (harvard.edu)
  • The increasing utilisation of the new AEDs presents a fresh challenge of identifying new toxicities and drug interactions. (bmj.com)
  • Drug utilisation studies provide an insight into the current standards and trends of drug prescriptions. (bmj.com)
  • Results of search for 'su:{Drug utilization review. (who.int)
  • By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won't receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays. (catsone.com)
  • The identified maternity waiting home interventions and their effectiveness in improving facility-based delivery uptake were narratively synthesized and reported following the preferred reporting items for systematic reviews and meta-analysis reporting guidelines. (unair.ac.id)
  • Medical ReviewStream™ implements electronic data interchange (EDI) interfaces, which can further streamline the utilization review process. (concentra.com)
  • This study aims to review telehealth literature comprehensively since the pandemic started. (um.edu.my)
  • Best Practices, LLC undertook this benchmarking research to examine how leading biopharma companies currently utilize the Promotion Review Editor position, highlight those that are planning to, and explore those that are not. (best-in-class.com)
  • Be coordinated with other components of the MCHIP that use or could benefit from utilization review data. (virginia.gov)
  • After initial screen, 2 reviewers reviewed full texts for inclusion and performed data extraction and risk of bias assessment using the Newcastle-Ottawa scale. (nih.gov)
  • Segmented data in the report focuses on Large Pharma and organizations that already have or are planning to have a Promotion Review Editor. (best-in-class.com)
  • Research data has been collected via literature review and questionnaire developed and prepared by the researcher. (ed.gov)
  • 11. Reviews data of specific to utilization management functions and reports as requested. (bilh.org)
  • Understands, interprets and explains, and uses data for utilization management activities. (bilh.org)
  • Ability to understand, interpret, and explain data for utilization management functions Demonstrates highly developed written, verbal, and presentation skills. (bilh.org)
  • This authorized, structured and ongoing review is related to pharmacy benefit managers. (wikipedia.org)
  • Geary L, Aronius J, Wettermark B, Hasselström J, Sjöborg B, von Euler M. Sociodemographic factors are associated with utilization of statins after ischemic stroke/TIA. (janusinfo.se)
  • What is the salary of a utilization review specialist in Florida? (rubyradio.fm)
  • Utilization Review Coordinator Salary in Florida - How much does a Utilization Review Coordinator make in Florida? (rubyradio.fm)
  • The review involves your medical records, but you won't need to undergo a physical exam for purposes of determining whether the treatment is proper. (kfeej.com)
  • Through utilization review, medical treatment for an injured City of Chicago worker can be certified or denied. (kfeej.com)
  • Once the utilization review process is invoked and written notice is received, medical providers are supposed to submit to the utilization review. (kfeej.com)
  • The solution is a Utilization Management partner with a robust service platform that enhances your medical management strategy. (nexmc.com)
  • Utilization review licenses and certificates are typically issued for organizations conducting either medical or workers' compensation reviews. (harborcompliance.com)
  • Possesses mid to high-level proficiency in navigating the Electronic Medical Record and applications related to utilization management. (bilh.org)
  • Our panel of expert medical advisors manage your medical review needs in a cost effective and responsive manner --- saving you time and money. (concentra.com)
  • He has authored and coauthored over 150 peer reviewed journal articles on medical toxicology and other topics, including several articles on the detection and toxicology of ethylene glycol. (cdc.gov)
  • Concurrent Review - Utilization review that is conducted during a patient's course of treatment. (harborcompliance.com)
  • The aim of this study was to describe the utilization of the Perceived Stress Scale (PSS) during recovery in SS. (nursingcenter.com)
  • We excluded studies that included only subsets of people with CP, or those that only reported therapy service utilization. (nih.gov)
  • Finally, the report probes the best practices and challenges of utilizing the Promotion Review Editor position in a modern biopharma company. (best-in-class.com)
  • Different kinds of utilization review may be used for current, past, or proposed future care. (kfeej.com)
  • did not require True Care to administratively appeal Auto Club's utilization review through the procedures in MCL 500.3157a and Mich Admin Code, R 500.65. (chiromi.com)
  • The review uses an adapted conceptual framework from quality of care and human rights-based frameworks to analyse published scientific studies. (who.int)
  • Our panelists, supported by our independent clinical review platform, have clinical expertise needed to provide reviews with evidence-based recommendations quickly and cost-effectively. (nexmc.com)
  • A. The MCHIP licensee shall have a utilization review and management process that complies with the requirements of §§ 32.1-137.7 through 32.1-137.16 of the Code of Virginia and this chapter. (virginia.gov)
  • This report also examines the involvement of Promotion Review Editors in electronic submissions and review process of promotional materials, functional location and reporting of Promotion Review Editors, and the realtive number of products supported by them on average. (best-in-class.com)
  • The reviewer decides whether to go forward with treatment or order tests based on information provided as part of the utilization review process. (kfeej.com)
  • When utilization management information flows quickly and accurately, employers can focus on the core decision-making process in claims management. (nexmc.com)
  • Future research should focus on evaluating the implementation of men specific utilization strategies. (edu.au)
  • utilization review serves to evaluate how effective and efficient office visits, hospitalizations and treatment are in light of these norms. (kfeej.com)
  • A current review will look at your ongoing treatment. (kfeej.com)
  • A prospective utilization review may be used to determine whether a recommended future treatment is proper. (kfeej.com)
  • Defendant's utilization review concluded that plaintiff's treatment exceeded the American College of Occupational and Environmental Medicine (ACOEM) guidelines' recommendations for the frequency and duration of treatment for injuries like the plaintiff's patient. (chiromi.com)
  • Overall, the treatment approaches used in the last decade comply with guideline recommendations, despite variations in levodopa and dopamine agonist utilization. (jphres.org)
  • Local production and access to medicines in low- and middle-income countries : a literature review and critical analysis. (who.int)