ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2000
How valid are utilization review tools in assessing appropriate use of acute care beds?
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2000. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 43 citations in OpenAlex.
- The increasing impact of length of stay "outliers" on length of stay at an urban academic hospital.BMC health services research · 2021Article
- Quality improvement time-saving intervention to increase use of a clinical decision support tool to reduce low-value diagnostic imaging in a safety net health system.BMJ open quality · 2021Article
- Pattern of Investigation Reflects Risk Profile in Emergency Medical Admissions.Journal of clinical medicine · 2015Article
- How efficient is patient discharge following lower limb arthroplasty?Perioperative medicine (London, England) · 2015Article
- Article
- In-depth analysis of delays to patient discharge: a metropolitan teaching hospital experience.Clinical medicine (London, England) · 2012Article
- Discharge against Medical Advice among Inpatients with Heart Disease in Iran.The journal of Tehran Heart Center · 2012Article
- An evaluation of the appropriateness of advice and healthcare contacts made following calls to NHS Direct Wales.BMC health services research · 2009Article
- Factors associated with patients who leave acute-care hospitals against medical advice.American journal of public health · 2007Article
- Determining appropriateness for rehabilitation or other subacute care: is there a role for utilisation review?Australia and New Zealand health policy · 2007Article
- Instrument for objective assessment of appropriateness of surgical bed occupancy: validation study.BMJ (Clinical research ed.) · 2003Article
- Discharges against medical advice: time to address the causes.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2002Article
- Validity of utilization review tools.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2000Article
- Validity of utilization review tools.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2000Article
- Validity of utilization review tools.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2000Article
- Validity of utilization review tools.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2000Article
- Validity of utilization review tools.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2000Article
- Utilization review: can it be improved?CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2000Article
Corrections and comments
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDespite their widespread acceptance, utilization review tools, which were designed to assess the appropriateness of care in acute care hospitals, have not been well validated in Canada. The aim of this study was to assess the validity of 3 such tools--ISD (Intensity of service, Severity of illness, Discharge screens), AEP (Appropriateness Evaluation Protocol) and MCAP (Managed Care Appropriateness Protocol)--as determined by their agreement with the clinical judgement of a panel of experts.
methodsThe cases of 75 patients admitted to an acute cardiology service were reviewed retrospectively. The criteria of each utilization review tool were applied by trained reviewers to each day the patients spent in hospital. An abstract of each case prepared in a day-by-day format was evaluated independently by 3 cardiologists, using clinical judgement to decide the appropriateness of each day spent in hospital.
resultsThe panel considered 92% of the admissions and 67% of the subsequent hospital days to be appropriate. The ISD underestimated the appropriateness rates of admission and subsequent days; the AEP and MCAP overestimated the appropriateness rate of subsequent days in hospital. The kappa statistic of overall agreement between tool and panel was 0.45 for ISD, 0.24 for MCAP and 0.25 for AEP, indicating poor to fair validity of the tools.
interpretationPublished validation studies had average kappa values of 0.32-0.44 (i.e., poor to fair) for admission days and for subsequent days in hospital for the 3 tools. The tools have only a low level of validity when compared with a panel of experts, which raises serious doubts about their usefulness for utilization review.
Indexed as
Identifiers
10906913PMC1231368W2130617082What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.