Utilization review in a large mental hospital.

Abstract

FTER the Social Security Amendments of 1965 were passed, all hospitals in the United States were under considerable pressure to prepare themselves for medicare by the target date of July 1, 1966. To participate in tile medicare program, an institution must meet certain requirements, one of which is to develop and implement a utilization review systern, to be carried out by a special committee. The task of tile utilization review committee is to review the duration of stay and the professional services furnished for a sample of admissions and to review each case of “continuous extended duration.” Before they do so, the committee must define various terms, such as “continuous extended duration,” in some practical way. General hospitals had been using utilization review before the advent of medicare. However, it had not previously been part of the formal structure of psychiatric hospitals. And although utilization check lists for various physical diseases existed as part of the medical utilization studies, there was no comparable check list for psychiatric disorders that could be used by large public mental hospitals. The problems of making such a list are considerable, compared with devising a check list of relevant factors in physical diseases. For example, there are standards for length of stay and specific treatments for many medical conditions, such as appendicitis or gall bladder disease, but not for psychiatric illnesses. Specific medical disorders call for specific diagnostic tests, such as the electrocardiogram for cardiac conditions, whereas a more general series of clinical examinations is the