" " Reviews | EvaluCare
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Doctor in Office
Reviews to Results
EvaluCare translates care review into practical insights that enhance quality, safety, experience while improving quality rankings and financial outcomes.
Customer directed reviews enable customers to focus on high-impact needs and concerns.
 
Learn how EvaluCare's CARE-AI helps hospitals improve quality while decreasing costs.
Doctor With Patient

Continuous Quality & Mortality Review

Academic medicine level quality and mortality reviews focus on quality of care by reviewing care against thousands of clinical guidelines and standards of care. Customers can select the health service to further align focus review to service specific care requirements. 

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Reviews answer quality of care questions such as, Were acceptable procedures performed appropriate for the patient's indications? Providing clinical teams with the details behind the answer. 

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Use focused reviews to prepare for Root Cause Analysis for adverse events, 

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Reviews include an assessment of four requirements for medical malpractice, Duty, Breach of Duty, Causation and Injury from negligence and flag concerning encounters. 

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Peer Review

OPPE/FPPE

The Joint Commission's OPPE and FPPE standards establishes clear expectations for continuous evaluation of the professional practice of medical staff.

Programs should have a clear design structure, goals, review process that includes frequency, data collection, interpretation/assessment and standard of care evaluation. 

At the core of any OPPE and FPPE program is how organizations perform evaluations. 

EvaluCare's healthcare quality professionals have redesigned OPPE/FPPE programs at hospitals and have designed an intuitive user interface that allows customers to upload multiple patient records and perform and analysis against clinical guidelines and standards of the healthcare service, while allow customers to direct the review toward specific areas of concern.

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General Peer Review Focus Areas

  • Care Delivered/Procedures Performed

  • Documentation Requirements - Quality and Accuracy

  • Appropriateness of Tests Ordered

  • Appropriateness of Procedures Performed

  • Clinical guidelines and Standards to be Met

  • Transition of Care and Discharge Planning

  • Plus: Customer Directed Concerns

Doctor and Patient

Utilization Review

Utilization reviews are where care meets operations. Where clinical documentation and coding and billing lead to appropriate reimbursement for care delivery. And where patient severity of illness is properly reflected to impact quality performance.

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Reviews dozens of established categories of care impacting interpretations of medical necessity, severity of illness variables, quality and reimbursement. Additionally customer may choose to respond to insurance denials with thorough and robust defense of clinical decision making. 

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The EvaluCare healthcare quality experts have led improvement initiatives to improve utilization review processes at hospitals and health systems that have led to millions in reimbursement benefits. â€‹â€‹â€‹â€‹â€‹â€‹

Patient Tracers

Patient tracers are essential for evaluating care quality. Tracers are the patient's journey or "road map" to assess processes from admission to discharge, evaluating 112 categories of care. Tracers identify system vulnerabilities and promote a culture of continuous, patient-and-family-centered improvement that goes beyond mere compliance. 

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​Patient tracers help inform quality programming efforts by performing a system analysis of the entire patient encounter not just isolated tasks. It identifies weaknesses in systems and their interfaces. 

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This supports an "ever-readiness" approach to proactively prevent harm and reduce risk. 

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