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Medical Practice Strategies:  Systems Based Practice - Business Laws Ethics

Janet Lerman, J.D.

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CME Test - Class 5
Relevant terms
Utilization Review
UR Activities
UM
Examples
Improving Quality
Techniques
Tools
Considerations
Required Readings
Suggested Readings
New News Class 5

 

For CME Test - Class 5 - Click Here

Class Description - Class 5

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 system-based practices to improve quality is examined. Also, this class considers the effects of computerized medical information as used in system-based practices.  Further, this class explores concepts underlying total quality management (TQM) and continuous quality improvement (CQI).

Class 5 Topics:    QUALITY AND UTILIZATION REVIEW

I. UTILIZATION REVIEW

II. UTILIZATION REVIEW ACTIVITIES

III. UTILIZATION MANAGEMENT 

IV. EXAMPLES OF INAPPROPRIATE UTILIZATION

V. IMPROVING QUALITY

VI. QUALITY ASSURANCE TECHNIQUES

VII. TOOLS FOR IMPROVING QUALITY

A.  EVIDENCE BASED MEDICINE/ MEDICAL GUIDELINES/ CRITICAL PATHWAYS OR CARE MAPS

B. BENCHMARKING

C. ELECTRONIC MEDICAL RECORDS (EMR)

D. TOTAL QUALITY MANAGEMENT (TQM) AND CONTINUOUS QUALITY IMPROVEMENT (CQI)

Key Objectives

bullet1.     Identify key tools for improvement by providers in the process and outcomes of care.

 

bullet2.     Synthesize how "total quality management" and utilization review effects the provider.

 

bullet3.     Analyze the effects of computerized medical information as used in managed care.

Review 

bullet1.     Give three examples of inappropriate utilization and suggest alternatives for each that improves efficiency.

 

bullet2.     Explain the concept "total quality management" and the process of utilization review.

 

bullet3.     Describe advantages and disadvantages of "critical pathways", "benchmarking", and "electronic medical records".

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