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Determining appropriateness for rehabilitation or other subacute care: is there a role for utilisation review?

BACKGROUND: Rehabilitation and other forms of subacute care play an important role in the Australian health care system, yet there is ambiguity around clinical definitions of subacute care, how it differs from acute care, where it is best done and what resources are required. This leads to inconsist...

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Detalles Bibliográficos
Autores principales: Poulos, Christopher J, Eagar, Kathy
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839097/
https://www.ncbi.nlm.nih.gov/pubmed/17352832
http://dx.doi.org/10.1186/1743-8462-4-3
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author Poulos, Christopher J
Eagar, Kathy
author_facet Poulos, Christopher J
Eagar, Kathy
author_sort Poulos, Christopher J
collection PubMed
description BACKGROUND: Rehabilitation and other forms of subacute care play an important role in the Australian health care system, yet there is ambiguity around clinical definitions of subacute care, how it differs from acute care, where it is best done and what resources are required. This leads to inconsistent and often poorly defined patient selection criteria as well as a lack of research into efficient models of care. METHODS: A literature review on the potential role of utilisation review in defining levels of care and in facilitating appropriate care, with a focus on the interface between acute care and rehabilitation. RESULTS: In studies using standardised utilisation review tools there is consistent reporting of high levels of 'inappropriate' bed days in acute care settings. These inappropriate bed days include both inappropriate admissions to acute care and inappropriate continuing days of stay. While predominantly an instrument of payers in the United States, concurrent utilisation review programs have also been used outside of the US, where they help in the facilitation of appropriate care. Some utilisation review tools also have specific criteria for determining patient appropriateness for rehabilitation and other subacute care. CONCLUSION: The high levels of 'inappropriate' care demonstrated repeatedly in international studies using formal programs of utilisation review should not be ignored in Australia. Utilisation review tools, while predominantly developed in the US, may complement other Australian patient flow initiatives to improve efficiency while maintaining patient safety. They could also play a role in the identification of patients who may benefit from transfer from acute care to another type of care and thus be an adjunct to physician assessment. Testing of the available utilisation review tools in the Australian context is now required.
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spelling pubmed-18390972007-03-30 Determining appropriateness for rehabilitation or other subacute care: is there a role for utilisation review? Poulos, Christopher J Eagar, Kathy Aust New Zealand Health Policy Research BACKGROUND: Rehabilitation and other forms of subacute care play an important role in the Australian health care system, yet there is ambiguity around clinical definitions of subacute care, how it differs from acute care, where it is best done and what resources are required. This leads to inconsistent and often poorly defined patient selection criteria as well as a lack of research into efficient models of care. METHODS: A literature review on the potential role of utilisation review in defining levels of care and in facilitating appropriate care, with a focus on the interface between acute care and rehabilitation. RESULTS: In studies using standardised utilisation review tools there is consistent reporting of high levels of 'inappropriate' bed days in acute care settings. These inappropriate bed days include both inappropriate admissions to acute care and inappropriate continuing days of stay. While predominantly an instrument of payers in the United States, concurrent utilisation review programs have also been used outside of the US, where they help in the facilitation of appropriate care. Some utilisation review tools also have specific criteria for determining patient appropriateness for rehabilitation and other subacute care. CONCLUSION: The high levels of 'inappropriate' care demonstrated repeatedly in international studies using formal programs of utilisation review should not be ignored in Australia. Utilisation review tools, while predominantly developed in the US, may complement other Australian patient flow initiatives to improve efficiency while maintaining patient safety. They could also play a role in the identification of patients who may benefit from transfer from acute care to another type of care and thus be an adjunct to physician assessment. Testing of the available utilisation review tools in the Australian context is now required. BioMed Central 2007-03-13 /pmc/articles/PMC1839097/ /pubmed/17352832 http://dx.doi.org/10.1186/1743-8462-4-3 Text en Copyright © 2007 Poulos and Eagar; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Poulos, Christopher J
Eagar, Kathy
Determining appropriateness for rehabilitation or other subacute care: is there a role for utilisation review?
title Determining appropriateness for rehabilitation or other subacute care: is there a role for utilisation review?
title_full Determining appropriateness for rehabilitation or other subacute care: is there a role for utilisation review?
title_fullStr Determining appropriateness for rehabilitation or other subacute care: is there a role for utilisation review?
title_full_unstemmed Determining appropriateness for rehabilitation or other subacute care: is there a role for utilisation review?
title_short Determining appropriateness for rehabilitation or other subacute care: is there a role for utilisation review?
title_sort determining appropriateness for rehabilitation or other subacute care: is there a role for utilisation review?
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839097/
https://www.ncbi.nlm.nih.gov/pubmed/17352832
http://dx.doi.org/10.1186/1743-8462-4-3
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