For CME Test - Class 5 - Click Here
QUALITY AND UTILIZATION REVIEW
This class introduces the concept of utilization review and quality assurance and will identify key tools for improvement by providers in the process and outcomes of care. Critical pathways, benchmarking and the electronic medical record as tools used by Managed Care Organizations to improve quality is examined. Also, this class considers the effects of computerized medical information as used in managed care. Further, this class explores concepts underlying total quality management (TQM) and continuous quality improvement (CQI).
Class 5 Topics: QUALITY AND UTILIZATION REVIEW
II. UTILIZATION REVIEW ACTIVITIES
IV. EXAMPLES OF INAPPROPRIATE UTILIZATION
VI. QUALITY ASSURANCE TECHNIQUES
VII. TOOLS FOR IMPROVING QUALITY
A. EVIDENCE BASED MEDICINE/ MEDICAL GUIDELINES/ CRITICAL PATHWAYS OR CARE MAPS
C. ELECTRONIC MEDICAL RECORDS (EMR)
D. TOTAL QUALITY MANAGEMENT (TQM) AND CONTINUOUS QUALITY IMPROVEMENT (CQI)
Key Objectives
 | 1. Identify key tools for improvement by providers in the process and outcomes of care. |
| 2. Synthesize how "total quality management" and utilization review effects the provider. |
| 3. Analyze the effects of computerized medical information as used in managed care. |
Review
| 1. Give three examples of inappropriate utilization and suggest alternatives for each that improves efficiency. |
See: Alan H. Rosenstein, "Cost- Effective Health Care: Tools for Improvement," Health Care Management Review (Spring, 1994): 57 - 58. John R. Griffith and Andrew Pattullo, "Championship Management for Healthcare Organizations," Journal of Healthcare Management, 45:1 (January/February, 2000): 17 - 31.
| 2. Explain the concept "total quality management" and the process of utilization review. |
See: Jonathan W. Cutright, Steven C. Stolp-Smith, Eric S. Edell, M.D., "Strategic Performance Management: Development of a Performance Measurement System at the Mayo Clinic," Journal of Healthcare Management, 45:1 (January/ February, 2000): 58 - 68.
| 3. Describe advantages and disadvantages of "critical pathways", "benchmarking", and "electronic medical records". |
See: Amy Y. Chen, M.D., Dacid Callender, M.D., Carol Mansyur, et al., "The Impact of Clinical Pathways on the Practice of Head and Neck Oncologic Surgery," Archives Otolaryngol Head and Neck Surgery, Vol. 126 (March, 2000): 322 - 326. William J. Strawbridge, Ph.D., Margaret I. Wallhagen, Ph.D., and Sarah J. Shema, "New NHLBI Clinical Guidelines for Obesity and Overweight: Will They Promote Health?," American Journal of Public Health (March 2000): 340 -343. Martin S. Karpiel, "Benchmarking Facilitates Process Improvement in the Emergency Department," Healthcare Financial Management (May, 2000): 54 - 59. Stephen F. Jencks, M.D., "Clinical Performance Measurement - A Hard Sell," JAMA (April 19, 2000): 2015 - 2016. James G. Lenhart, M.D., Karen Honess, Deborah Covington, DrPH, et al., "An Analysis of Trends, Perceptions, and Use Patterns of Electronic Medical Records Among Us Family Practice Residency Programs," Family Medicine (February, 2000): 109 - 113.