Decision Modeling in Case Selection for Medical Utilization Review

Abstract

A situation is described in which large amounts of physician time are being spent reviewing patient records. In order to promote efficient use of their time, careful selection of the cases they review is called for. A methodology is developed to elicit criteria from physicians for the use of nonphysicians in case selection. The methodology, called the direct approach to approximate decision models, involves the use of interviews and questionnaires asking the physician directly about the criteria he uses, rather than inferring his criteria by indirect means. He is asked to interpret these criteria in a way that will allow a nonphysician to use them for case selection so that the resulting model is an approximation to the physician's decision process.