Biomedical subjects
Publications and source records attributed to M J Goran.
The authors advocate using the Internet to support clinical care teams dedicated to monitoring patients who can most benefit. Care teams will provide such services as home monitoring for vital signs and supplying patient information. They will work with physicians in managing care. The result should be a stronger provider-patient relationship.
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Over the past several years, the PSRO hospital review system has evolved to such an extent as to merit re-examination of its objectives, accomplishments and potential, as well as the obstacles to success that still remain. The combination of review experience, political and funding pressures has reshaped the hospital review system. There is still controversy concerning the relative emphasis of the program on quality or costs, but there is no longer any question about the priority goal of the program for the remainder of this decade--to reduce the excessive use of hospital care and services that exists throughout the country. There is widespread and growing evidence of significant variation in hospital practice patterns from region to region and hospital to hospital. Elimination of much of the variation would benefit the quality of patient care and help to contain costs. Improvements in PSRO hospital review, particularly profile analysis and medical care evaluation studies, make possible the exposure of apparent local problems in hospital quality and utilization and the precise definitions of their causes. Many PSROs have made substantial progress in the application and refinement of these techniques. The current state of the art is described in detail. Still to be determined over the next several years is the extent to which PSROs will be able to succeed in correcting these problems and whether the support and cooperation PSROs need form sister agencies and the political process will be adequate.
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The professional standards review organization (PRSO) program offers both a challenge and an opportunity to the academic medical center. Application by the local PSRO of objective measures of the quality and medical necessity of services challenges the medical center to demonstrate that its self-image of excellence is correct. Educating and training medical students and house staff in methods of self-evaluation and peer review could have a major impact on both the success of the PSRO program and the quality of medical care. Evaluation of the educational programs of the medical center through review of actual practice behavior presents an unparalleled means for improvement in undergraduate, graduate, and continuing medical education.
PSROs will require a broad range of information with which to develop and sustain the review process for long-term care institutions. The general approach to PSRO review of long-term care described here has been approved by the National Professional Standards Review Council. In implementing this approach, the Bureau of Quality Assurance recognizes that long-term care review is in an evolutionary state, and will initiate a series of demonstrations designed to test and refine various acceptable approaches, rather than require a single uniform methodology for PSRO use. The test period will provide the Bureau with an opportunity to fully assess the feasibility, costs, and impact on the quality of care of various approaches. The basic elements of long-term care review remain unchanged. A general outline of the currently proposed PSRO long-term care review system is described in the middle section of the paper.
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The major purpose of the PSRO program is to improve the quality of medical care. Peer review is expected not only to detect problems but to analyze causes, and to develop, implement, and evaluate corrective programs. Such peer-review efforts are in themselves educational. In addition, educational programs focusing on identified deficiencies must be organihe educational efforts of local health facilities and organizations of all types is urged. Although PSRO's will not specifically underwrite continuing health-care education, they should provide a community-wide means for integrating patient-care review with continuing medical education.
A method that can be used to classify the severity of health problems and measure change in health status is described. The "staging" concept provides a system which classifies patients with similar medical conditions into clusters useful for patient care evaluation. The method defines different levels of severity: Stage I-disease with no complications or problem of minimal severity; Stage II-disease with local complications or problem of moderate severity; and Stage III-disease with systemic complications or a problem of a serious nature. Examples of the method are given and the value of the approach is described for the evaluation of the hospitalized and ambulatory patient.
The 1972 Social Security amendments contained the landmark Professional Standards Review Organization (PSRO) provisions as well as several sections upgrading existing utilization review (UR) requirements under Medicare and Medicaid. With issuance of the PSRO Program Manual and the recent publication of the new UR regulations, HEW for the first time has brought Medicare and Medicaid hospital review requirements into conformity and made them compatible with and supportive of the PSRO program. This article defines the PSRO hospital review system, describes how the three major components-concurrent review, medical care evaluation studies, and profile analysis-interrelate and provides examples of each of these components. Under utilization review requirements or PSRO, hospitals will be required to implement an integrated system of review designed to assure appropriate utilization practices and improve the quality of care. These aims are to be accomplished through the application of concepts of peer review, the use of norms, criteria, and standards, the identification of deficiencies in the quality, administration, or appropriateness of health care services, and their correction through linkage with programs of continuing medical education. Although PSROs are initially responsible for review in hospitals, they will likely provide the locus for a community-wide system of peer review for all services provided under National Health Insurance.
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Explore the source record for details and available documents.
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As managed care gains increasing influence over the American health financing system, economic pressures and emerging market realities have created a fertile climate for wishful thinking on the part of hospital executives and physicians. Rather than accept the inevitability of reducing excess capacity and incomes, providers cling to self-serving myths about managed care's strategic direction. Here are five of these myths along with their contrasting market realities.
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