Procedures for Determining the Level of Utilization of Health Personnel and Healthcare.

In determining the level of utilization of health personnel and health care, resource planning, allocation and the evaluation of the appropriateness, medical needs and efficiency of health care service and procedures must be carefully analysed. Such analysis is of very important for health care institutions to ensure effective and

efficient patient care delivery.

Today, patient medical records 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.

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.

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.