Design and development of a utilization review program

This paper describes the work that has been under way in the Portuguese government hospi-tal sector, with respect to the use of an adapted version of the Appropriateness Evaluation Pro-tocol (AEP). Modifications to the original sys-tem were determined through a series of experiments at pilot hospitals and reliability and user profile studies were subsequently con-ducted using the modified criteria. Results were of great value in terms of the identification and quantification of problems. On average, approximately one in every four non-obstetric admissions and one in every 2 days of stay were deemed inappropriate and 75 % of all inappropriate days were related to patients who were ready for discharge. It is expected that the use of the modified AEP will be extended and enhanced over the next few years. In this regard, advantage has already been taken of the implementation of an output-based funding system, combining retrospective statistical analysis of the hospitals ' inpatient databases with targeted reviews of individual patients