COMPUTERIZED DECISION-SUPPORT FOR CONCURRENT UTILIZATION REVIEW USINGTHE HELP SYSTEM

Objective: Development and evaluation of computerized concurrent utili zation review (UR) support taking advantage of a clinically rich compu terized patient database. Design: The Automated Support System for Uti lization Review (ASSURE) applies the Appropriateness Evaluation Protoc ol (AEP) Day of Care criteria to computerized patient data in the HELP hospital information system. This paper reports the development, veri fication, and validation of ASSURE. Measurements: Implementation corre ctness was verified by measuring agreement with a nurse reviewer, usin g separate sample sets for all 20 criteria for a total of 560 current inpatients. Usefulness in detecting inappropriate days of care was val idated by two nurse reviewers who were crossed with manual and compute r-assisted review methods in a blocked design for 168 current inpatien ts. Agreement with reviewers, sensitivity, specificity, positive predi ctive value, and negative predictive value were measured. Results: Agr eement was very good for satisfaction of criteria, and good for approp riateness of day of care. A patient day identified by ASSURE as potent ially inappropriate would be twice as likely to be judged inappropriat e by a reviewer as a randomly selected patient day. Review of the 10% of patient days identified as potentially inappropriate by ASSURE woul d identify approximately 21% of the inappropriate days of care. Conclu sion: ASSURE is a clinically useful tool for screening adult acute car e patients for inappropriate days of care, and promises to make a majo r contribution to reducing health care costs. The prognosis for succes sful routine clinical use is good.