Booth B M, Ludke R L, Fisher E M
HSR&D Field Program (152/NLR) VA Medical Center, North Little Rock, AR 72114.
Am J Med Qual. 1994 Summer;9(2):68-73. doi: 10.1177/0885713X9400900205.
One important question for a utilization management program is whether the utilization review instrument is consistent or stable when used on many occasions by the same abstractor (intrarater reliability) or by several abstractors (inter-rater reliability). As part of a nationwide study of inappropriate utilization of inpatient services by the Department of Veterans Affairs, we conducted a thorough investigation of the inter-rater reliability of a widely used utilization review instrument by 27 nurse abstractors. All abstractors were extensively trained, both by the developers of the instrument and by use of practice medical records. A standard protocol for resolving questions was implemented, with immediate communication of decisions to abstractors. The results of three reliability assessments, conducted immediately after formal training, after several weeks of reviewing practice records, and midway through review of the study records, demonstrated good to excellent reliability, both when comparing the nurse abstractors with a physician gold standard and among themselves. Therefore, with appropriate training and monitoring, utilization management programs in large hospitals, multihospital systems, and other health care organizations needing to examine inpatient utilization should feel confident that they can achieve reviews that would be in close agreement with physician and other nurse abstractors. Such confidence should increase the acceptability of utilization management programs.
对于利用管理计划而言，一个重要问题是，当同一名提取员多次使用（提取员内部信度）或多名提取员使用（提取员间信度）时，利用审查工具是否具有一致性或稳定性。作为退伍军人事务部对住院服务不当利用情况进行的一项全国性研究的一部分，我们对27名护士提取员使用的一种广泛应用的利用审查工具的提取员间信度进行了全面调查。所有提取员都接受了该工具开发者以及通过使用实际病历进行的广泛培训。实施了一个解决问题的标准方案，并将决定立即传达给提取员。在正式培训后、经过几周的实际病历审查后以及在研究病历审查进行到一半时进行的三项信度评估结果表明，无论是将护士提取员与医生金标准进行比较，还是提取员之间相互比较，信度都良好到优秀。因此，通过适当的培训和监测，大型医院、多医院系统以及其他需要审查住院利用情况的医疗保健组织中的利用管理计划应该有信心，它们能够实现与医生和其他护士提取员高度一致的审查。这种信心应该会提高利用管理计划的可接受性。
