Utilization review based on practitioner profiles

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Abstract
Focused utilization review efforts to date have centered on patient categories, i.e., diagnosis, service, or classification. Since the patient's length of stay is mostly controlled by the attending practitioner, it seemed logical to use practitioner profiles to focus review. The profiles developed compare each practitioner's patients, case-mix-adjusted, using diagnosis-related groups, to statewide length-of-stay norms. Standards (range of acceptable variations from the norm) can be adjusted to increase or decrease the impact of the review. After experience, standards were set that resulted in a significant decrease in the average length of stay and a resultant significant drop in patient days.

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