QUALITY ASSURANCE - COST OF UTILIZATION REVIEW AND EDUCATIONAL VALUE OF MEDICAL AUDIT IN A UNIVERSITY HOSPITAL

  • 1 January 1976
    • journal article
    • research article
    • Vol. 80  (1) , 122-129
Abstract
The components of mandated quality assurance, i.e., utilization review (UR) and medical audit, were analyzed to determine their cost-effectiveness and educational value in a university hospital. At The New York Hospital-Cornell Medical Center [USA], UR expenditures in 1975 were $205,272-$6.71/admission or $0.69/patient day. The average costs per admission and per patient day in teaching hospitals in the New York area in 1975 were $10.42 and $0.93, respectively. These costs will increase markedly in 1976 because of admission review. Since 1972 about 9500 hospital charts were reviewed annually to identify an average of 6 patients/year who required the intervention of the UR committee because of unnecessarily prolonged length of stay. The cost of identifying each patient was $34,212. In the university hospital, the active participation of the graduate (house) staff in patient care renders the requirements for certification/recertification of the need for hospital services or admission review superfluous. From Sept. 1973,-Dec. 1975, 15 studies of evaluation of medical care (medical audit) were completed at an average cost of $4788 per audit. In 10 audits the principal criticism was inadequate documentation of data in the hospital record. Nine audits were critical of excessive use of laboratory services and deviations of practice were identified in 7 audits. Medical audit fails to achieve its objective to identify the educational needs of the hospital staff. A more satisfactory and less costly form of medical audit should be devised. Clinical studies, published in scientific journals, should be considered in the context of medical audit.

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