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The focus of concurrent UM tends to be on reducing denials and placing the patient at a medically appropriate point of care. [8] Concurrent review may include a case-management function that includes coordinating and planning for a safe discharge or transition to the next level of care. Retrospective review considers whether an appropriate ...
Aging populations, a changing disease spectrum, and the progress and change in technology of health care become the major problems which lead to increasing of health care costs. [4] Then, how to use drug utilization evaluation and drug economy evaluation to improve and optimize the allocation of medical and health resources is a major problem ...
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 ).
The retrospective review helps detect patterns in prescribing, dispensing or administering drugs, or following with any post-therapy issues. [6] DUR is helpful for all areas of healthcare by providing feedback on therapy performance and outcomes. Therapy reviews highlight prescribing behaviors compared to pre-set criteria or treatment protocols ...
The generic model used in the United States is the chronic care model, which holds that health care does not only involve change in the patient and that high-quality disease care counts the community, the health system, self-management support, delivery system design, decision support, and clinical information systems as important elements in ...
Clinical documentation improvement (CDI), also known as "clinical documentation integrity", is the best practices, processes, technology, people, and joint effort between providers and billers that advocates the completeness, precision, and validity of provider documentation inherent to transaction code sets (e.g. ICD-10-CM, ICD-10-PCS, CPT, HCPCS) sanctioned by the Health Insurance ...
Comparative effectiveness research (CER) is the direct comparison of existing health care interventions to determine which work best for which patients and which pose the greatest benefits and harms. The core question of comparative effectiveness research is which treatment works best, for whom, and under what circumstances. [ 1 ]
Medical Care Research and Review is a peer-reviewed academic journal that covers the field of health care. The editor-in-chief is Thomas D'Aunno (Columbia University Mailman School of Public Health). It was established in 1944 and is currently published by SAGE Publishing.