Utilization management, managed care, clinical

Ellis, S.L. Carter, B.L. Malone, D.C. Billups, S.J. Okano, G.J. Valuck, R.J. Barnette, D.J. Sintek, C.D. Covey, D. Mason, B. Jue, S. Carmichael, J. Guthrie, K. Dombrowski, R. Geraets, D.R. Amato, M. Clinical and economic impact of ambulatory care clinical pharmacists in management of dyslipidemia in older adults The IMPROVE study. Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers. Pharmacotherapy 2000, 20 (12), 1508-1516. 

As health delivery systems move toward total managed care, the need for outcomes studies will increase. Issues to be addressed by outcomes research will include clinical efficacy of interventions, health-related quality of life, patient satisfaction, employee productivity, and resource utilization. Pharmacists can either participate in or direct outcomes research. Outcomes studies may also be used to support a pharmacy position for interventions. 

Other organizations that provide guidance on model clinical practices are those that measure pharmacy quality and utilization in the managed care area. The primary organizations are as follows ... 

Umpierrez GE, Watts NB, Phillips LS. Clinical utility of beta-hydroxybutyrate determined by reflectance meter in the management of diabetic ketoacidosis. Diabetes Care 1995 18 137-8,... 

So here is an attempt at a definition. Clinical decision intelligence is the application of IT to help gather, understand, and act on all available data in clinical practice, healthcare management and administration, and medical research, and where appropriate the automatic utilization of data to control certain clinical and research processes. Its aims are to encourage best practices to improve the quality of patient care by enhancing speed and efficiency to reduce safety risks and needless costs in clinical treatment, diagnosis, management, and administration to monitor and log interactions for accountability, culpability, liability and repudiation and to facilitate biomedical research and pharmaceutical development where based on inclusion of clinical and related data. 

The implementation of pharmaceutical care is supported by tools that facilitate patient care, including equipment to assess medication therapy adherence and effectiveness, clinical resource materials, and patient education materials. Tools may include computer software support, drug utilization evaluation (DUE) programs, disease management protocols, etc. 

Access to healthcare services is a marker of primary care quality, because acute episodes of asthma are avoidable if they are managed and appropriately treated in the community. Gaps in access to medical services between urban and rural areas exist, and include such things as convenience of transportation, range of services provided locally, as well as the cost for medical treatment. The previous literature indicates that a lack of medical services and specialists are more common in rural than in urban areas (Rural Healthy People 2010), and there is a low utilization efficiency of hospice services in rural areas (Gessert et al. 2006) in addition, disparities exist in the threshold for admission to hospital or clinic care, between urban and rural physicians (Russo et al. 1999). 

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