Developing a Framework of Utilization Management for Secondary Hospital Services in Iran

Abstract

Abstract Introduction: the use of health cares to respond to the daily-increasing demand of people for hospital sources is very necessary throughout the world. Purpose: The present study aims to develop a framework for utilization management of level-2 hospital services in Iran. Materials and Methods: Based on a mixed method study, the research collects data in terms of its purpose by means of various methods such as the systematic review, observation of documents, face-to-face interview, focus group discussion and delphi technique. The target community consists of experts and theoreticians in the domain of health and hospital management at various steps of research. Findings: The framework for utilization management of hospital services has been presented at three levels of pre-hospital, hospital and after patient discharge. The pre-hospital level includes the primary care, family doctor and referring system, primary care case management, patient management and self-care. The hospital level includes the utilization review, hospital-based case management, health information management, knowledge management, discharge planing, payment method, and human resource development. The level of after patient discharge includes the post-discharge case management, transfer care, and patient care system at the last stages of life. Increase in efficacy, promotion of quality, increase in satisfaction, optimum consumption and reduction in costs were considered as the purposes of framework for consumption management of hospital services . Conclusion: To reach the highest level of quality and efficacy in delivering the health services, the level-2 utilization management of hospital services needs to consider the management of framework’s structural elements. In this regard, ensuring the coordination between the various organs, supervision and culturalization for optimum consumption is the necessity. Keyword: Framework for Hospital Utilization Management, Utilization Review, Health Care, Secondary Care, Iran.