American College of Occupational and Environmental Medicine, Elk Grove Village, Illinois.
J Occup Environ Med. 2020 Jun;62(6):e273-e286. doi: 10.1097/JOM.0000000000001893.
: Utilization review (UR) is a process that assesses aspects of a treating provider's care plans and then provides recommendations to payors/insurance carriers, third party administrators, etc, concerning the appropriateness of the proposed care. UR has become an integral part of medical practice and has influenced medical care within the workers' compensation (WC) system and is mandated in several states and jurisdictions. This guidance statement from the American College of Occupational and Environmental Medicine (ACOEM) reviews structural elements of UR programs and proposes a possible template for operational standards. UR has a unique role in protecting patients and educating providers on evidence-based guidelines, new research, and best practices.
: 利用审查（UR）是一个评估治疗提供者护理计划各个方面的过程，然后向付款人/保险公司、第三方管理员等提供有关拟议护理的适当性的建议。UR 已成为医疗实践的一个组成部分，并影响了工人赔偿（WC）系统内的医疗保健，并且在几个州和司法管辖区被强制要求。美国职业与环境卫生医学学院（ACOEM）的这份指导声明审查了 UR 计划的结构要素，并提出了一个可能的操作标准模板。UR 在保护患者和教育提供者有关循证指南、新研究和最佳实践方面发挥着独特的作用。
