The evolution of hospital utilization review methods in the United States

Abstract

The purpose of this paper is to provide a description of utilization review (UR) methods that have been used in the United States and the direction UR is likely to take in the future. In contrast to the European studies reported in this issue, which consist primarily of empirical studies quantifying the magnitude of inappropriate hospital utilization, the focus of this paper is on the methods used to perform UR operationally. Particular attention will be paid to the predominant form of UR employed in the United States, concurrent review of the need for a hospital level of care, and on the criteria used to assess appropriateness of hospital admissions and days.