Access

You are not currently logged in.

Access your personal account or get JSTOR access through your library or other institution:

login

Log in to your personal account or through your institution.

Optimal Investigation Policies under Selected PSRO Procedures

David A. Dittman and Robert P. Magee
Medical Care
Vol. 18, No. 10 (Oct., 1980), pp. 1032-1047
Stable URL: http://www.jstor.org/stable/3764033
Page Count: 16
  • More info
  • Cite this Item
Optimal Investigation Policies under Selected PSRO Procedures
Preview not available

Abstract

This article presents a methodology for utilization review which aids the local Professional Standards Review Organization (PSRO) in selecting optimal timing of Concurrent Stay certification by diagnosis. This procedure is accomplished by modeling patients' admissions, inpatients stays and discharges for each diagnosis as a stochastic process which is audited under the PSRO by three utilization review techniques: preadmission, concurrent and retrospective review. The timing of concurrent stay certification is determined so that the maximum benefits are derived for the utilization review cost expended. The methodology presented here is a tool to aid local PSRO management in determining the most cost-beneficial utilization review process to be utilized in their jurisdiction. It is not an attempt to demonstrate the effectiveness of our utilization review policy over another in general. On the contrary, while the model is generalizable to every PSRO, the utilization review policies resulting from any application are situation-specific. The major contributions of this article are new insight into modeling the utilization review process and the provision of a methodology for which computer programs exist and are readily available to any PSRO that should desire to determine its utilization review procedure in this cost-benefit framework. In order to apply the model it is necessary that certain parameters specific to the application site be estimated or assumed. Exact procedures to aid the PSRO in parameter estimation is the subject of current investigation.

Page Thumbnails

  • Thumbnail: Page 
1032
    1032
  • Thumbnail: Page 
1033
    1033
  • Thumbnail: Page 
1034
    1034
  • Thumbnail: Page 
1035
    1035
  • Thumbnail: Page 
1036
    1036
  • Thumbnail: Page 
1037
    1037
  • Thumbnail: Page 
1038
    1038
  • Thumbnail: Page 
1039
    1039
  • Thumbnail: Page 
1040
    1040
  • Thumbnail: Page 
1041
    1041
  • Thumbnail: Page 
1042
    1042
  • Thumbnail: Page 
1043
    1043
  • Thumbnail: Page 
1044
    1044
  • Thumbnail: Page 
1045
    1045
  • Thumbnail: Page 
1046
    1046
  • Thumbnail: Page 
1047
    1047