Medical Utilization Review Using Indicators “ORTHOPAEDICS†in Orthopaedic Inpatients under Universal Coverage Policy Admitted to Siriraj Hospital

Abstract

Objective: Utilization review is very important especially in universal coverage policy. In Siriraj Hospital the utilization review began in 2002, and the Department of Orthopaedic Surgery developed the indicators “ORTHOPAEDICS†to assess the appropriateness of medical utilization. This study is designed to study the effectiveness of medical utilization review by using indicators “ORTHOPAEDICS†in orthopaedics, public inpatients under universal coverage policy in terms of expenses, the appropriateness, length of hospital stay and the satisfaction of the patients.
Methods: 301 orthopaedic inpatients were divided in 2 groups: Group A included 149 patients, 100 men and 49 women. Their average age was 32.7 years old. From June 1, 2003 - May 31, 2004, each patient was prospectively reviewed regarding their daily utilization in terms of expenses, appropriateness of medical utilization by using indicators “ORTHOPAEDICSâ€. Their length of hospitalization was measured, as well as and their satisfaction evaluated. Group B was the control which included 152 patients, 98 men and 54 women. Their average age was 34.8 years old. No intervention was performed and the data was collected only in expenses and the length of hospital stay for each patient retrospectively from June 1, 2002 - May 31, 2003.
     The expenses and the length of hospital stay of both groups were compared and analyzed.
     The appropriateness in Group A was studied by using indicators “ORTHOPAEDICS†which were:
     O = Operation; R = Relative weight rate; T = Type of treatment; H = Hospital stay;
O = Occurrence of complication; P = procedures; A = admission; E = expenses; D = drugs;
I = Investigation; C = Care map according to CPG of 12 diseases; S = Satisfactions score from 0-10 minimum to maximum, by asking the patients about the satisfaction in term of results of treatment.
Results: The total expenses per patient in group A was 24,566.74 baht but in group B was 30,484.53 baht. The expense in group A was 5,917.79 baht reduction which was statistically significant difference (P<0.05). The average length of hospital stay in group A was 8.24 days, whereas in group B was 10.93 days. It reduced 2.69 days after utilization review was implemented. The appropriateness of utilization was found in the procedures, drugs and investigation without inappropriateness (0%). The inappropriateness in admission was 26.9% because the physician forgot to take blood examination and laboratory investigation before admission and it was done in the ward without any effect the treatment. And the average satisfaction score in group A was 9.6.
Conclusion: “ORTHOPAEDICS†was useful and helpful indicator to significantly reduce the expense per patient and the length of hospitalization without reducing patient satisfaction and quality of treatment.