Abstract
ABSTRACT Expert system software was developed to assist in determining the appropriate treatment for substance abuse patients. The software applies criteria, called the Mental Health Review Criteria (MHRC(©)), which are widely used by utilization review professionals who make treatment decisions in managed health care plans. The expert system also collects a database of patient information, including the paths that led to all treatment decisions. The expert system was evaluated by comparing its decisions with those of managed care nurse reviewers and with those of a panel of physicians who helped to develop the MHRC. A set of 70 cases were assessed by the expert system, the nurse reviewers, and the physician panel. The possible decision outcomes were approval of providers' requests for inpatient detoxification or referral for further consideration. The expert system and the nurse reviewers each agreed with the physician panel in about 85 percent of the cases. Both the expert system and the nurse reviewers were more likely to agree with the physician panel in the cases that they approved for inpatient treatment than in the cases that they referred for further consideration.
Published Version
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