From 2002 to 2003, research staff at URAC studied utilization management companies to learn how they use utilization management technology and processes to identify and manage potential patient safety problems.
Utilization management, a technique widely used in the health care industry to evaluate the necessity of medical interventions, has the potential to contribute to patient safety but has not been routinely used for this purpose.
URAC is a national organization that develops standards for and accredits or certifies non-HMO health care organizations, including preferred provider organizations and self-insured plans managed by employers or third party administrators.
Key findings from an article in Managed Care Quarterly and a report, Patient Safety Capabilities of Utilization Management Programs, include:
- The majority of companies interviewed address patient safety indirectly, as part of general quality management.
- Utilization management programs are primarily designed to identify potential over-use of selected services; their approach to identifying misuse or under-use of recommended services is less systematic.
- Many of the interviewed companies have automated protocols that trigger additional case review (e.g., a request for an extended length of stay, unexpected mortality or unexpected transfer to higher intensity care).
Industry leaders interviewed in the project called for additional research to support a direct role for utilization management in promoting patient safety. Once a clear role has been established, strategies that could be adopted to support a patient safety agenda for utilization management include:
- Creating a culture of safety by:
- Enhancing patient safety-related policies, procedures and training.
- Including patient-safety criteria in clinical review standards.
- Partnering with training and educational organizations.
- Matching patients' health care needs with appropriate services by using guidelines for hospital referrals, case management and other services.
- Enhancing information technology systems to support decision-making and communications.
- Identifying high-priority clinical conditions and situations where utilization management companies can standardize assessment and data collection.
The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $49,988.
RWJF Scholar examines neighborhood-based death rates from opiate-based painkiller overdoses, compared with heroin overdose deaths.
Unengaged patients can incur costs of up to 21% higher than patients who are highly engaged in care. This suite of materials from RWJF's AF4...
Adverse working conditions contribute substantially to the risk of depression for working-age adults, according to new research from a team ...
RWJF Nurse Faculty Scholar Jennifer Bellot writes about losing her grandmother to complications from a medical error.
This month the Johns Hopkins Bloomberg School of Public Health published a special issue of its magazine devoted to food.
Learn how The Robert Wood Johnson Foundation is dedicated to building a culture of health in Risa Lavizzo-Mourey's 2014 annual message.
America is not getting good value for its health care dollar. These resources explore issues of cost and value of health care.
This revolutionary concept gives patients the tools they need improve their own health and health care by transforming the doctor-patient re...
List of most current annual reports.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
CDC: Reducing High-risk Antibiotic Prescriptions Could Also Reduce Deadly Infections - Poorer Women Most Likely to Be Caught in ‘Vicious’ Ca...
The reconvened Commission to Build a Healthier America will provide new guidance in three key areas: early childhood, healthy communities, a...