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International Journal for Quality in Health Care 7:253-260 (1995)
© 1995 International Society for Quality in Health Care
The Evolution of Hospital Utilization Review Methods in the United States*
Associate Professor, Program in Health Care Management and Department of Operations Management, Boston University Boston, Massachusetts, USA
The purpose of this paper is to provide a description of utilization review (UR) methods that have been used in the United States and the direction UR is likely to take in the future. In contrast to the European studies reported in this issue, which consist primarily of empirical studies quantifying the magnitude of inappropriate hospital utilization, the focus of this paper is on the methods used to perform UR operationally. Particular attention will be paid to the predominant form of UR employed in the United States, concurrent review of the need for a hospital level of care, and on the criteria used to assess appropriateness of hospital admissions and days.
Keywords: Utilization review, utilization management, appropriateness of hospital utilization, appro-priateness criteria
J. D. Restuccia Dr PH, Associate Professor, School of Management, Boston University, 621 Common wealth Avenue, Boston, MA 02215, USA. Tel.
*An earlier version of this paper was presented at the Biomed Project Annual Workshop held in Bergamo (Italy), 23–25 September 1994.
Received for publication April 7, 1995. Accepted for publication May 18, 1995.
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