Compare and contrast utilization review and utilization management in health care. What are the similarities and the differences between each type of assessment? (Hint: One is generally a prospective process, and the other is generally a retrospective process).

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Using the information in the required readings as well as some additional research in peer
reviewed sources, complete your Case Assignment by answering the following:

  1. Compare and contrast utilization review and utilization management in health care. What are the similarities and the differences between each type of assessment? (Hint: One is generally a prospective process, and the other is generally a retrospective process).
  2. Explain the specific role of each method in providing value-based health care. Who benefits from the method—the health care system, the insurance company, and/or the patient?
  3. Articulate how individual case management is critical to a hospital’s long-term survival. In what way does this practice protect your patients while keeping your doors open for business?
  4. What are the ethical pitfalls to be aware of in performing these types of quality reviews? What must health care managers be aware of in terms of ethical pitfalls and also potential unintended negative consequences?

5 pages required 

SOURCES:

Baker, J. (2018). Improving quality of care through utilization management [Video file]. Retrieved from https://youtu.be/g-T-YeP53nY

Carasso, S. (2017). Is that test necessary? The key to laboratory utilization management.
The Journal of Medical Practice Management: MPM, 33(3), 160-164. Retrieved from the
Trident Online Library.

Desai, S., Gruber, P. F., Eiting, E., Seabury, S. A., Mack, W. J., Voyageur, C., . . . Terp, S. (2017). The effect of utilization review on emergency department operations. Annals of Emergency Medicine, 70(5), 623-631.e1. Retrieved from the Trident Online Library.

El-Othmani, M. M., Sayeed, Z., Ramsey, J. A., Abaab, L., Little, B. E., & Saleh, K. J. (2019).
The joint utilization management program: Implementation of a bundle payment model and
comparison between year 1 and 2 results. The Journal of Arthroplasty, 34(11), 2532-2537.
Retrieved from the Trident Online Library.

Parast, M. M., & Golmohammadi, D. (2019). Quality management in healthcare
organizations: Empirical evidence from the Baldrige data. International Journal of Production
Economics, 216, 133-144. Retrieved from the Trident Online Library.

Suklar, S. (2018). Quality assurance system at primary level of healthcare. Izzivi Prihodnosti, 3(1), 21-53. Retrieved from the Trident Online Library.

Wakefield, E., Keller, H., Mianzo, H., Nagaraj, C. B., Tawde, S., & Ulm, E. (2018). Reduction
of health care costs and improved appropriateness of incoming test orders: The impact of
genetic counselor review in an academic genetic testing laboratory. Journal of Genetic
Counseling, 27(5), 1067-1073. Retrieved from the Trident Online Library.

Describe what type of article it is and how you can tell. For example, is it a primarily a review of existing research, a report of new research, or an analysis of a professional issue? 

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Please compose an outline of the term paper assignment described below. Your outline must be at least 2 pages long and you must answer all questions asked in the assignment as described below. The outline is a brief summary of your term paper.

Term Paper Assignment: Exploration of a Professional Journal Article in Psychology

A recent research article from a scholarly journal in the field of developmental psychology. It must have been published less than 12 years ago.

Select an article: British Journal of Social Psychology, or Journal of Positive Psychology

Before proceeding, please ensure that your selected article meets the following criteria:

Full-text is available in online database. Is a scholarly journal article in the field of psychology. Was published less than 12 years ago.

 

Write a paper of at least 2000 (five pages)

1.  Identify your selected article, using a proper APA-style reference.

2.  Describe what type of article it is and how you can tell. For example, is it a primarily a review of existing research, a report of new research, or an analysis of a professional issue?  Describe how you can you tell.  If it is a research article, identify the type of research involved.     Summarize what you have learned about the content of the article.  Be sure to include the main purpose of the article, the major findings, and how the major findings are supported.      Explain how this article fits into the overall field of developmental psychology.  Then, identify the corresponding chapter(s) from your textbook. Explain why this article is different and similar from articles in non-scholarly periodicals, such as magazines and newspapers.

Your assignment must follow these formatting requirements:

At least five pages long (2000 words).   Be typed in APA format, double-spaced, using Times New Roman font (size 12), with one-inch margins on all sides.      Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page is not included in the required assignment page length.

Choose the scenario that most interests you. Note: Before selecting a scenario, view the Discussion 4 Forum to see if any colleagues have already posted. If so, select a letter that has not yet been chosen. All nine (a–i) letters should addressed before a student repeats a letter.

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Discussion: Confounding Variables

Internal validity in a research study is the extent to which changes in the dependent variable can confidently be attributed to the influence of the independent variable rather than to possible confounding variables. In other words, was it really the independent variable that had an effect on the dependent variable or did something else cause the effect?

For example, presume that an instructor wants to try a new reading efficiency strategy to improve reading comprehension of college students in an online course. The instructor divides the class into two equal groups. One group (the experimental group) reads a passage using the new reading strategy taught by the instructor. The other group (the control group) reads the same passage but is not exposed to the new strategy. Next, both groups of students complete a reading comprehension test. The assumption is that if the group exposed to the new reading strategy scored higher than the other group, the new reading strategy is effective.

What else could explain the difference in scores? Is it possible that the students enrolled in the group that learned the new strategy already had high reading comprehension skills? What if this group already knew more about the information in the reading passage? Could the instructor have inadvertently biased the study because he taught the new reading strategy, and he selected the reading passages that both groups read?

Possible situations, or reasons, that could interfere with obtaining accurate results are called confounds, and could be a threat to the internal validity of a study. It is important to keep in mind though, that the presence of a possible confounding variable in a study does not necessarily mean it is responsible for obtained results. Rather, the independent variable (e.g., the reading intervention) may have actually had an effect on the dependent variable (the test results).

In this Discussion, you will examine possible confounding variable(s) in research studies from your course textbook and apply methodology for addressing and/or eliminating the possible confound(s).

To prepare:

  • Read Chapter 12 in your course text.
  • Read the “Thinking Critically About Research” scenarios (a—i) in Chapter 12, pages 256–258.
  • Choose the scenario that most interests you. Note: Before selecting a scenario, view the Discussion 4 Forum to see if any colleagues have already posted. If so, select a letter that has not yet been chosen. All nine (a–i) letters should addressed before a student repeats a letter.

For your chosen scenario, determine the possible confounding variable(s) (there may be more than one), and consider how they might be eliminated using research designs presented in the readings (e.g., 2×2 factorial design).

Note: You can assume that random assignment took care of any potential differences in the groups; therefore, group differences are not a potential confound.

With these thoughts in mind:

By Day 3
  1. Indicate the letter of the scenario you selected in the “Subject” field of your post. You should be addressing a scenario different from those posted, unless your colleagues have already addressed all nine scenarios. Identify and explain the possible confounding variable(s) (e.g., demand characteristics, placebo effect) in your chosen scenario.
  2. Drawing from the Learning Resources this week, explain a specific research design (e.g., 2×2 factorial design, repeated measures design) the researcher(s) could use to control for confounding variables.

Note: Be sure to support the responses within your Discussion post, and in your colleague reply, with evidence from the assigned Learning Resources.

Describe ethical guidelines and law governing practice of mental health.Specific ethical guidelines and legal requirements of practice identified are appropriate to real-life scenario.

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In this assignment, you will discuss the issues pertaining to informed consent in conducting evaluations and apply ethical decision making to a scenario in which there is a professional ethical conflict.

Tasks:

Review vignette 3 from the following article:

After you have read the vignette, answer the following questions in a 2- to 3-page paper:

  • Should the evaluation, which is requested by the warden, be completed? Why or why not?
  • Would your answer change if the psychologist were not a member of APA? Why or why not?
  • What multicultural/diversity issues would one need to consider if the inmate in the vignette were a homosexual, African-American male who was raised in an adoptive, single-parent household? What ethical and multicultural issues would a professional need to consider in conducting an evaluation of an individual with this background?
  • Support your answers with appropriate references in APA style.

Assignment Component Proficiency

Apply ethical guidelines and legal requirements of practice to specific ethical dilemma.

Appropriate and specific ethical guidelines and legal requirements of practice are identified and applied to ethical dilemma.

Application is accurate and appropriate to resolving or addressing the ethical dilemma(s). (48 points)

Present well-reasoned arguments to support chosen course of action.

Chosen action is ethical and legal.

Arguments presented are well-reasoned and supported by scholarly literature, professional ethical guidelines, and/or the law.

Arguments clearly support the course of action on a broad level.(40 points)

Addressed multicultural/diversity considerations in the evaluationConsiderations presented are appropriately situated and supported by scholarly literature, professional ethical guidelines, and/or the law.(24 points)

Describe ethical guidelines and law governing practice of mental health.Specific ethical guidelines and legal requirements of practice identified are appropriate to real-life scenario. Description of guidelines and laws are clear and complete, and they are grounded in scholarly literature. ( 48 points)

Ability to present self professionally.

Responses were generally clear, concise, organized, and well-supported using multiple sources in adherence with APA style.
The student’s responses cited most sources in correct APA style.
Most references were cited parenthetically and included in the reference list.
Minimal and correct use of direct quotations. (40 points)