The procedures for determining the
level of utilization of health personnel and health care include resource
planning, allocation and the evaluation of the appropriateness, medical needs
and efficiency of health care service and procedures. Such analysis is of
increasing importance for health care institutions to ensure effective and
efficient patient care delivery.
level of utilization of health personnel and health care include resource
planning, allocation and the evaluation of the appropriateness, medical needs
and efficiency of health care service and procedures. Such analysis is of
increasing importance for health care institutions to ensure effective and
efficient patient care delivery.
Patient medical records today include
a large number of entries related to patient conditions along with treatments
and procedures received. Utilization analysis based on such observational data
collected through normal course of care delivery and carried out in a
systematic manner can be leveraged to improve care delivery in many ways.
a large number of entries related to patient conditions along with treatments
and procedures received. Utilization analysis based on such observational data
collected through normal course of care delivery and carried out in a
systematic manner can be leveraged to improve care delivery in many ways.
Two areas in particular have attracted
significant attention recently. The first is the notion of hot spotting, which is the ability to identity in a
timely manner patients who are heavy users of the system and their patterns of
use, so that targeted intense intervention and follow up programs can be put in
place to address their needs and change the existing, potentially ineffective,
utilization pattern. The second is anomaly detection, where the goal is to
identify utilization patterns that are unusual given patients’ clinical
characteristics, including both underutilization and overutilization. The
former may indicate a gap in medical service that if left unaddressed could
result in further deterioration of patient’s condition leading to situations
requiring more costly and less effective interventions. The latter incurs
unnecessary cost and waste of precious healthcare resources that could have
been directed towards cases in real need.
significant attention recently. The first is the notion of hot spotting, which is the ability to identity in a
timely manner patients who are heavy users of the system and their patterns of
use, so that targeted intense intervention and follow up programs can be put in
place to address their needs and change the existing, potentially ineffective,
utilization pattern. The second is anomaly detection, where the goal is to
identify utilization patterns that are unusual given patients’ clinical
characteristics, including both underutilization and overutilization. The
former may indicate a gap in medical service that if left unaddressed could
result in further deterioration of patient’s condition leading to situations
requiring more costly and less effective interventions. The latter incurs
unnecessary cost and waste of precious healthcare resources that could have
been directed towards cases in real need.
Estimates have put the waste caused by
overutilization at more than 30% of the total medical cost and this has been
confirmed by real world medical management experiences.
overutilization at more than 30% of the total medical cost and this has been
confirmed by real world medical management experiences.
