{"id":"https://openalex.org/W1992013738","doi":"https://doi.org/10.1097/00005650-199002000-00001","title":"Reliability and Validity of Utilization Review Criteria","display_name":"Reliability and Validity of Utilization Review Criteria","publication_year":1990,"publication_date":"1990-01-01","ids":{"openalex":"https://openalex.org/W1992013738","doi":"https://doi.org/10.1097/00005650-199002000-00001","mag":"1992013738","pmid":"https://pubmed.ncbi.nlm.nih.gov/2299897"},"language":"en","primary_location":{"id":"doi:10.1097/00005650-199002000-00001","doi":"https://doi.org/10.1097/00005650-199002000-00001","is_oa":false,"landing_page_url":"https://doi.org/10.1097/00005650-199002000-00001","pdf_url":null,"source":{"id":"https://openalex.org/S79233773","display_name":"Medical Care","issn_l":"0025-7079","issn":["0025-7079","1537-1948"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","fnege-3","jufo-2","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medical Care","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5070771506","display_name":"Ira Strumwasser","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Ira Strumwasser","raw_affiliation_strings":["Michigan Health Care Education and Research Foundation, Detroit 48226"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Michigan Health Care Education and Research Foundation, Detroit 48226","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5078560017","display_name":"Nitin Vasant Paranjpe","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Nitin V. Paranjpe","raw_affiliation_strings":["From the Michigan Health Care Education and Research Foundation, Detroit, Michigan","Michigan Health Care Education and Research Foundation"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"From the Michigan Health Care Education and Research Foundation, Detroit, Michigan","institution_ids":[]},{"raw_affiliation_string":"Michigan Health Care Education and Research Foundation","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5109860269","display_name":"David L. Ronis","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210089489","display_name":"Health Services Research & Development","ror":"https://ror.org/0083hz885","country_code":"US","type":"facility","lineage":["https://openalex.org/I1322918889","https://openalex.org/I2799886695","https://openalex.org/I4210089489"]},{"id":"https://openalex.org/I4210122509","display_name":"Ann Arbor VA Medical Center","ror":"https://ror.org/039n0s143","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1322918889","https://openalex.org/I2799886695","https://openalex.org/I4210102099","https://openalex.org/I4210122509","https://openalex.org/I4210127612"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"David L. Ronis","raw_affiliation_strings":["From the Health Services Research and Development Program, Veterans Administration, Ann Arbor, Michigan","School of Nursing"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"From the Health Services Research and Development Program, Veterans Administration, Ann Arbor, Michigan","institution_ids":["https://openalex.org/I4210089489","https://openalex.org/I4210122509"]},{"raw_affiliation_string":"School of Nursing","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5013620940","display_name":"David A. Share","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210093267","display_name":"Blue Cross Blue Shield of Michigan Foundation","ror":"https://ror.org/00q2zjc87","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I4210093267"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"David Share","raw_affiliation_strings":["Blue Cross and Blue Shield of Michigan, Detroit, Michigan","Blue Cross and Blue Shield of Michigan"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Blue Cross and Blue Shield of Michigan, Detroit, Michigan","institution_ids":["https://openalex.org/I4210093267"]},{"raw_affiliation_string":"Blue Cross and Blue Shield of Michigan","institution_ids":["https://openalex.org/I4210093267"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5107432393","display_name":"Larry J. Sell","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210093267","display_name":"Blue Cross Blue Shield of Michigan Foundation","ror":"https://ror.org/00q2zjc87","country_code":"US","type":"nonprofit","lineage":["https://openalex.org/I4210093267"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Larry J. Sell","raw_affiliation_strings":["Blue Cross and Blue Shield of Michigan, Detroit, Michigan","Blue Cross and Blue Shield of Michigan"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Blue Cross and Blue Shield of Michigan, Detroit, Michigan","institution_ids":["https://openalex.org/I4210093267"]},{"raw_affiliation_string":"Blue Cross and Blue Shield of Michigan","institution_ids":["https://openalex.org/I4210093267"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5070771506","https://openalex.org/A5078560017"],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":10.5063,"has_fulltext":false,"cited_by_count":126,"citation_normalized_percentile":{"value":0.97772058,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":89,"max":98},"biblio":{"volume":"28","issue":"2","first_page":"95","last_page":"111"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.5268999934196472,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.5268999934196472,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T14400","display_name":"Medical Coding and Health Information","score":0.12120000272989273,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T13309","display_name":"Reliability and Agreement in Measurement","score":0.07569999992847443,"subfield":{"id":"https://openalex.org/subfields/1804","display_name":"Statistics, Probability and Uncertainty"},"field":{"id":"https://openalex.org/fields/18","display_name":"Decision Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/utilization-review","display_name":"utilization review","score":0.9700000286102295},{"id":"https://openalex.org/keywords/appropriateness-evaluation-protocol","display_name":"Appropriateness Evaluation Protocol","score":0.8220000267028809},{"id":"https://openalex.org/keywords/reliability-statistics","display_name":"reliability statistics","score":0.5090000033378601},{"id":"https://openalex.org/keywords/validity","display_name":"validity","score":0.9900000095367432},{"id":"https://openalex.org/keywords/retrospective-chart-review","display_name":"retrospective chart review","score":0.8029999732971191}],"concepts":[{"id":"https://openalex.org/C43214815","wikidata":"https://www.wikidata.org/wiki/Q7310987","display_name":"Reliability (semiconductor)","level":3,"score":0.6067125797271729},{"id":"https://openalex.org/C200601418","wikidata":"https://www.wikidata.org/wiki/Q2193887","display_name":"Reliability engineering","level":1,"score":0.5949376225471497},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.41363653540611267},{"id":"https://openalex.org/C127413603","wikidata":"https://www.wikidata.org/wiki/Q11023","display_name":"Engineering","level":0,"score":0.09485864639282227},{"id":"https://openalex.org/C163258240","wikidata":"https://www.wikidata.org/wiki/Q25342","display_name":"Power (physics)","level":2,"score":0.0},{"id":"https://openalex.org/C62520636","wikidata":"https://www.wikidata.org/wiki/Q944","display_name":"Quantum mechanics","level":1,"score":0.0},{"id":"https://openalex.org/C121332964","wikidata":"https://www.wikidata.org/wiki/Q413","display_name":"Physics","level":0,"score":0.0}],"mesh":[{"descriptor_ui":"D006279","descriptor_name":"Health Maintenance Organizations","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006761","descriptor_name":"Hospitals","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":true},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007600","descriptor_name":"Judgment","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008499","descriptor_name":"Medical Records","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008824","descriptor_name":"Michigan","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010343","descriptor_name":"Patient Admission","qualifier_ui":"Q000706","qualifier_name":"statistics & numerical data","is_major_topic":false},{"descriptor_ui":"D011336","descriptor_name":"Probability","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D014600","descriptor_name":"Utilization Review","qualifier_ui":"Q000379","qualifier_name":"methods","is_major_topic":true},{"descriptor_ui":"D015203","descriptor_name":"Reproducibility of Results","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D015397","descriptor_name":"Program Evaluation","qualifier_ui":"Q000379","qualifier_name":"methods","is_major_topic":false}],"locations_count":2,"locations":[{"id":"doi:10.1097/00005650-199002000-00001","doi":"https://doi.org/10.1097/00005650-199002000-00001","is_oa":false,"landing_page_url":"https://doi.org/10.1097/00005650-199002000-00001","pdf_url":null,"source":{"id":"https://openalex.org/S79233773","display_name":"Medical Care","issn_l":"0025-7079","issn":["0025-7079","1537-1948"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","fnege-3","jufo-2","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medical Care","raw_type":"journal-article"},{"id":"pmid:2299897","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/2299897","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medical care","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"display_name":"Good health and well-being","score":0.9537000060081482,"id":"https://metadata.un.org/sdg/3"}],"sustainable_development_goals_aurora":[],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":14,"referenced_works":["https://openalex.org/W1579033982","https://openalex.org/W1967582146","https://openalex.org/W1968850752","https://openalex.org/W1975879668","https://openalex.org/W1986118889","https://openalex.org/W2018827272","https://openalex.org/W2022161989","https://openalex.org/W2045798421","https://openalex.org/W2050974494","https://openalex.org/W2053059305","https://openalex.org/W2053154970","https://openalex.org/W2061058233","https://openalex.org/W2128609177","https://openalex.org/W2798358266"],"related_works":["https://openalex.org/W2130617082","https://openalex.org/W2134540599","https://openalex.org/W2095972773","https://openalex.org/W2138641348","https://openalex.org/W2171435781","https://openalex.org/W2411924983","https://openalex.org/W97136492","https://openalex.org/W2972573745","https://openalex.org/W1967582146","https://openalex.org/W1909653139"],"abstract_inverted_index":{"A":[0],"study":[1],"was":[2,72,109,142,199],"conducted":[3],"to":[4,32,50,84,135,144],"assess":[5],"the":[6,11,16,22,63,76,91,99,113,119,122,140,151,163,175,178,190,194],"reliability":[7,68],"and":[8,21,40,93,131,139],"validity":[9,41,105,161],"of":[10,47,52,55,65,69,106,115,124,127,160,162,177],"Appropriateness":[12],"Evaluation":[13],"Protocol":[14],"(AEP),":[15],"Standardized":[17],"Medreview":[18],"Instrument":[19],"(SMI)":[20],"Intensity-Severity-Discharge":[23],"criteria":[24],"set":[25],"(ISD),":[26],"three":[27],"utilization":[28],"review":[29],"instruments":[30,49,120,166],"used":[31],"determine":[33],"whether":[34],"inpatient":[35,197],"care":[36,198],"is":[37],"required.":[38,201],"Reliability":[39],"were":[42,95,133],"assessed":[43],"for":[44],"retrospective":[45],"application":[46],"these":[48],"charts":[51],"a":[53,125,187],"sample":[54],"119":[56],"medical":[57],"cases":[58],"from":[59],"21":[60],"hospitals":[61],"in":[62],"state":[64],"Michigan.":[66],"The":[67,104,129,157],"each":[70,85,107],"instrument":[71,77,108,179,195],"determined":[73],"by":[74,79,111],"having":[75],"applied":[78],"two":[80,165],"different":[81],"nurse":[82,116],"reviewers":[83,117],"hospital":[86],"record.":[87],"Results":[88,148],"indicated":[89],"that":[90,150,168,196],"AEP":[92,130],"ISD":[94,132],"moderately":[96,137],"reliable,":[97],"while":[98],"SMI":[100,141,152],"had":[101],"low":[102,146],"reliability.":[103],"tested":[110],"comparing":[112],"judgments":[114],"using":[118],"with":[121],"judgment":[123,191],"panel":[126],"physicians.":[128],"found":[134,143],"be":[136,155,172,183],"valid":[138],"have":[145],"validity.":[147],"suggested":[149],"should":[153,170,182],"not":[154,200],"used.":[156],"modest":[158],"level":[159],"other":[164],"suggests":[167],"payment":[169],"never":[171],"denied":[173,184],"on":[174,193],"basis":[176],"alone.":[180],"Payment":[181],"only":[185],"if":[186],"physician":[188],"confirms":[189],"based":[192]},"counts_by_year":[{"year":2025,"cited_by_count":1},{"year":2024,"cited_by_count":2},{"year":2023,"cited_by_count":3},{"year":2019,"cited_by_count":3},{"year":2018,"cited_by_count":2},{"year":2017,"cited_by_count":1},{"year":2016,"cited_by_count":1},{"year":2015,"cited_by_count":3},{"year":2014,"cited_by_count":4},{"year":2013,"cited_by_count":1},{"year":2012,"cited_by_count":3}],"updated_date":"2026-10-31T12:09:11.096373","created_date":"2016-06-24T00:00:00"}
