Targeting ambulatory care cases for risk management and quality management

Abstract

Means are needed to identify "highly productive" areas for quality review and risk management in ambulatory care; untargeted medical record reviews have too low a yield and too high a cost to be useful. Highly productive areas are those with important medical and economic consequences, large numbers of cases, and a reasonable potential that problems exist. This paper describes untoward event screens to identify highly productive areas for review based on hospital discharge diagnosis, procedure codes, and parameters such as length of stay and cancer staging. The approach proposed has been evaluated in six ambulatory care organizations and appears effective and efficient.