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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Donabedian model. The Donabedian model is a conceptual model that provides a framework for examining health services and evaluating quality of health care. [ 1] According to the model, information about quality of care can be drawn from three categories: “structure,” “process,” and “outcomes." [ 2] Structure describes the context in ...
v. t. e. Case management is a managed care technique within the health care coverage system of the United States. It involves an integrated system that manages the delivery of comprehensive healthcare services for enrolled patients. [1] Case managers are employed in almost every aspect of health care and these employ different approaches in the ...
e. A significant event audit (SEA), also known as significant event analysis, is a method of formally assessing significant events, particularly in primary care in the UK, with a view to improving patient care and services. To be effective, the SEA frequently seeks contributions from all members of the healthcare team and involves a subsequent ...
Discovering that patient safety had become a frequent topic for journalists, health care experts, and the public, it was harder to see overall improvements on a national level. What was noteworthy was the impact on attitudes and organizations. Few health care professionals now doubted that preventable medical injuries were a serious problem.
Affordable Health Care for America (H.R. 3962) America's Affordable Health Choices (H.R. 3200) Baucus Health Bill (S. 1796) Proposed. American Health Care Act (2017) Medicare for All Act (2021, H.R. 1976) Healthy Americans Act (2007, 2009) Health Security Act (H.R. 3600) Latest enacted. Affordable Care Act (H.R. 3590) Health Care and Education ...
In 2022, the U.S. spent more than 17%—about $4.5 trillion dollars—of its gross domestic product on health care, according to a Kaiser Family Foundation analysis of national health expenditure ...
Clinical audit. Clinical audit is a process that has been defined as a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. The key component of clinical audit is that performance is reviewed (or audited), to ensure that what ...
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