cme tests / vocabulary / utilization review / ur activities / um / examples / improving quality / techniques / tools / guidelines / benchmarking / emr / tqm / resources / current events

Class Description:

QUALITY AND UTILIZATION REVIEW

This class introduces the concept of utilization review aObjectivend quality assurance and will identify key tools for improvement by providers in the process and outcomes of care. Critical pathways, benchmarking and the electronic medical record as tools used by system-based practices to improve quality is examined. Also, this class considers the effects of computerized medical information as used in system-based practices.  Further, this class explores concepts underlying total quality management (TQM) and continuous quality improvement (CQI).

Topics:   

QUALITY AND UTILIZATION REVIEW

I. UTILIZATION REVIEW

II. UTILIZATION REVIEW ACTIVITIES

III. UTILIZATION MANAGEMENT

IV. EXAMPLES OF INAPPROPRIATE UTILIZATION

V. IMPROVING QUALITY

VI. QUALITY ASSURANCE TECHNIQUES

VII. TOOLS FOR IMPROVING QUALITY

A.  EVIDENCE BASED MEDICINE/ MEDICAL GUIDELINES/ CRITICAL PATHWAYS OR CARE MAPS

B. BENCHMARKING

C. ELECTRONIC MEDICAL RECORDS (EMR)

D. TOTAL QUALITY MANAGEMENT (TQM) AND CONTINUOUS QUALITY IMPROVEMENT (CQI)

Key Objectives:

  1. Identify key tools for improvement by providers in the process and outcomes of care.
  2. Synthesize how “total quality management” and utilization review effects the provider.
  3. Analyze the effects of computerized medical information as used in managed care.

Review:

  1. Give three examples of inappropriate utilization and suggest alternatives for each that improves efficiency.
  2. Explain the concept “total quality management” and the process of utilization review.
  3. Describe advantages and disadvantages of “critical pathways”, “benchmarking”, and “electronic medical records”.