An experience of utilization review in Europe: sequel to a BIOMED project

Objective. To develop and test a utilization review screening tool for use in European hospitals. Setting. In 1993 a group of researchers financed by a European Union grant reviewed the use of utilization review in Europe. They quickly noticed a la ck of specifically designed instruments able to take into account the healt h care and cultural differences across Europe, and available for use in dif ferent health care systems. Hence, they embarked upon the task of developin g and testing a utilization review screening tool for use in European hospi tals. Results. The European Union-Appropriateness Evaluation Protocol's list of r easons was developed and assessed. This is a common taxonomy that classifie s days identified as unnecessary and provides a list of levels of care to i dentify patients' needs. This new protocol not only substitutes for the mul tiple previous local versions of the Appropriateness Evaluation Protocol, b ut will also facilitate comparisons of the varying experiences in European countries. Main findings. Development of utilization review in Europe has been carried out mostly on a voluntary basis and the main objective was not control. Th e experience varies widely: from France, where utilization review is still developing and research has been implemented by local teams, to Portugal, w here utilization review programmes have been initiated by government author ities. At this point different initiatives in quality improvement, and more specifically in utilization review, are being developed within the Europea n context.