Relation between quality assessment and utilization review in a functioning PSRO.

Abstract

The Utah State Medical Association, through its peer-review foundation, the Utah Professional Review Organization, has implemented an integrated system of utilization reveiw and quality assessment linked to a program of continuing education. Nurse co-ordinators, employed by the Organization, screen all hospitalized patients covered by Titles XVIII, XIX and V as well as by subscribing private insurers. Approximately 10 per cent of hospitalized patients do not meet peer-generated criteria for admission review or length of stay and are screened out for peer review, The nurse co-ordinators collect data for retrospective quality assessment, identifying targets for continuing medical education. Preliminary data support the cost effectiveness of such a review program. Continuing qualtiy audit will test the effectiveness of education programs.