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  2. Drug utilization review - Wikipedia

    en.wikipedia.org/wiki/Drug_Utilization_Review

    Drug use/ utilization evaluation and medication utilization evaluations are the same as drug utilization review. [ 3 ] With the development of society and the economy, the costs of health care grows rapidly, and this becomes a burden on the worldwide health protection system. [ 4 ]

  3. Utilization management - Wikipedia

    en.wikipedia.org/wiki/Utilization_management

    Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...

  4. URAC - Wikipedia

    en.wikipedia.org/wiki/URAC

    URAC's accreditation programs include specialty pharmacy, digital health, utilization management, health plan, case management, and others. [4] In order to earn an accreditation, organizations submit various policies and procedures which are reviewed by a nurse or pharmacist and then the Accreditation Committee. [5] Accreditation lasts for ...

  5. Case management (US healthcare system) - Wikipedia

    en.wikipedia.org/wiki/Case_management_(US...

    The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of Case Management include the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient's right to self determination.

  6. Andersen healthcare utilization model - Wikipedia

    en.wikipedia.org/wiki/Andersen_healthcare...

    The Andersen healthcare utilization model is a conceptual model aimed at demonstrating the factors that lead to the use of health services. According to the model, the usage of health services (including inpatient care, physician visits, dental care etc.) is determined by three dynamics: predisposing factors, enabling factors, and need.

  7. Healthcare Cost and Utilization Project - Wikipedia

    en.wikipedia.org/wiki/Healthcare_Cost_and...

    The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of healthcare databases and related software tools and products from the United States that is developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ).

  8. Cumberlege Report 1986 - Wikipedia

    en.wikipedia.org/wiki/Cumberlege_Report_1986

    A committee was created in 1985 by the DHSS to review the care provided by nurses and health visitors outside hospitals and report on how resources could be used more effectively. [1] The committee focussed on primary care nursing. [1] Welsh and Scottish reviews also took place, on different timelines. [2] Julia Cumberlege was appointed chair. [3]

  9. Clinical peer review - Wikipedia

    en.wikipedia.org/wiki/Clinical_peer_review

    Clinical peer review, also known as medical peer review is the process by which health care professionals, including those in nursing and pharmacy, evaluate each other's clinical performance. [ 1 ] [ 2 ] A discipline-specific process may be referenced accordingly (e.g., physician peer review , nursing peer review ).