الفهرس 
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Abstract
One of the prominent cost-containment programmes in use in different countries is hospital utilisation review, which seeks to ensure that hospital care used is appropriate and necessary. However, it requires individual review of medical records by specially trained personnel. Therefore it is important to improve the efficiency with which review is conducted. The aim of the present study was to develop and implement a computer-aided utilisation management system and to evaluate the effects of this system in reducing inappropriate utilisation. The study was conducted at two hospitals in Alexandria; a Health Insurance Organisation hospital, namely, Gamal Abdel Nasser Hospital and a private hospital. The present study consisted of the following three distinct phases: I. Development Of Utilisation Review Computer-Aided System A. Design, development and testing of utilisation review application: The design was based on two linked database files one for the private hospital and the other for Gamal hospital. Microsoft Excel* version 5 was selected as the base program. The application was tested against errors using a data set of 15,000 patients. B. Collection of data for construction of length of stay database: Retrospective review of medical records of patients admitted to a private hospital in Alexandria was performed to construct reference databases. The total number of reviewed records was 674 general surgical and 278 orthopaedics. C- Selection, modification and testing of utilisation review instrument: The Appropriateness Evaluation Protocol (AEP) was the utilisation review instrument selected and used in the study. It is a diagnosis-independent explicit criteria set. Two versions of AEP were used in this study the Adult-Medical Surgical and the Elective Surgery versions. Minimal modifications of were made based on the pilot study, interviewing physicians at the study sections and literature review. II. Implementation Of The Computer-Aided Utilisation Review System The medical record of every admitted case to study sections was reviewed next day following the admission. The total number of reviewed records was 963 at general surgery section and 562 at orthopaedic section. An elective admission was judged appropriate if the patient was operated upon next day following admission because the hospital system recommend one pre-operative day. Admissions were cateogrised into matched cases (cases having similar characteristics to patients discharged from the private hospital) and unmatched cases (cases having dissimilar characteristics to patients discharged from the private hospital). Inappropriately admitted cases and appropriately admitted unmatched cases were reviewed on daily basis. Appropriately admitted matched cases were assigned a review date generated by the developed application corresponding to 50th percentile of length of stay for patients with similar characteristics discharged from the private hospital. Patients whose stay extended beyond the 50th percentile, review was conducted at the 75th or 95th percentiles of length of stay. Opinion of the study hospital’s specialists as well as the opinion of a group of external experts composed of professors of general surgery and orthopaedics at Alexandria Faculty of Medicine who accepted to participate was sought at the end of the study regarding conditions judged inappropriate using AEP. III. Evaluation Of Computer-Aided Utilisation Review System Evaluation was carried out to assess the technical aspects of the computerised application and the effects of the system in reducing the length of pre-operative, post-operative and average stay of non-operated cases at the study sections. The main findings of the study are : Regarding on selected patient characteristics and utilisation indicators, the proportion of operated upon cases was higher at the private hospital than at Gamal hospital for both general surgery and orthopaedic cases;