What term is used for a review of patient care focusing on appropriateness and cost effectiveness?

Utilization Review is a critical process used in healthcare to assess the necessity, appropriateness, and efficiency of the services provided to patients. This term specifically refers to evaluating whether the medical treatments or procedures that patients receive align with established guidelines and whether they are delivered in a cost-effective manner.

The focus of utilization review is on ensuring that patients receive the right level of care at the right time, which can include examining the necessity of services prior to their provision, as well as reviewing care retroactively after services have been rendered. This process plays a significant role in managing healthcare costs while simultaneously striving to maintain or improve the quality of patient care.

In contrast, quality assurance generally deals with overarching initiatives to improve the quality of care delivered to patients and may not specifically address cost-effectiveness. Case management focuses on coordinating care for patients to ensure they receive comprehensive services tailored to their needs. Patient advocacy involves supporting patients' interests and ensuring they understand their rights and options concerning their healthcare, rather than assessing the appropriateness or cost of care delivered.