Goldberg G A, Holloway D C
Med Care. 1975 Jun;13(6):474-85. doi: 10.1097/00005650-197506000-00004.
Utilization review has heretofore emphasized "length of stay" as the criterion for deciding when the patient is ready to leave the hospital. We suggest that "level of care" (the type, number, and/or intensity of a combination of physician, skilled nursing, and ancillary services) received by the patient should replace length of stay as the major "decision" criterion for deciding on continued hospitalization: "appropriate hospital placement" means the patient is currently receiving a level of care available only in the hospital. Length of stay should be the criterion for signaling intervals when patients are (re) reviewed to determine the currently needed level of care. Explicit criteria for determining when a patient is receiving a hospital level of care should be developed. Explicit criteria will increase objectivity, provide guidance to utilization review coordinators, and assist the hospital in defending its utilization review decisions to an intermediary or Professional Standards Review Organization (PSRO). Level of care will be reflected in a patient's "service profile," a listing of all the services being received by the patient on any given day of hospitalization. The services profile varies throughout hospitalization; hospitalization is appropriate when a patient's current services profile constitutes a level of care available only in the hospital.
此前，利用情况审查一直强调“住院时间”作为判定患者何时准备出院的标准。我们建议，患者接受的“护理级别”（医生、专业护理及辅助服务组合的类型、数量和/或强度）应取代住院时间，成为决定是否继续住院的主要“决策”标准：“适当的医院安置”意味着患者目前接受的护理级别只有在医院才能提供。住院时间应作为信号间隔的标准，用于在对患者进行（重新）审查时确定当前所需的护理级别。应制定明确的标准，以判定患者何时接受医院级别的护理。明确的标准将提高客观性，为利用情况审查协调员提供指导，并协助医院向中介机构或专业标准审查组织（PSRO）捍卫其利用情况审查决定。护理级别将反映在患者的“服务概况”中，即患者在住院的任何一天所接受的所有服务的清单。服务概况在整个住院期间会有所不同；当患者当前的服务概况构成只有在医院才能提供的护理级别时，住院就是适当的。
