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At least 19 recordsLinked to original sources
PubMed1982

Assessing medical practices through PSRO cooperative studies, an evaluation of Cesarean births in nine PSRO areas.

Nine Professional Standards Review Organizations jointly conducted an areawide medical care evaluation study of Cesarean births. Of 5,002 Cesarean births studied in 158 hospitals, only 1.1 per cent were judged to be unjustified procedures by local physician peer review. Although there was substantial geographic variation in rates of Cesarean birth (11.0%-18.3 per cent), no statistically significant pattern of variation was identified. Maternal outcomes and infant outcomes were generally good. This study demonstrates the potential for use of PSRO data in studying major issues in health care, as well as the practical constraints of such studies.

Cesarean Section↗
PubMed1977

PSRO and the dissolution of the malpractice suit.

The effect of PSRO on the practice of defensive medicine and the effect of the civil immunity provision on the numbers of malpractice suits may well be substantial. Cost savings in terms of control of overutilization and of the potential for patient injury engendered by that overutilization will ensue. While substantial, those effects will be small compared to the effect of PSRO on the present medical malpractice system. As a social system, malpractice has two positive purposes. It serves as a measure of quality control on outcomes of medical care, and it serves to compensate people for injuries received in medically related situations. How well it serves these purposes is unknown, but what few data exist indicate that it does not significantly enhance the quality of care nor provide an efficient method of compensation. It exists in theory because it is the final check and balance on physician practice--the only existing control on the outcomes of care. Until some system other than malpractice could be conceived which was at least as efficient in outcomes control, malpractice was destined to continue, and no other method of patient compensation could be considered seriously since the compensation and quality control aspects of malpractice were so inextricably bound. With the advent of PSRO, another means of outcomes control came into existence, and as PSRO becomes operational nationwide, that system will prove an efficient and effective system of control over the quality of outcomes of medical care. Within the environment of PSRO, malpractice as a system of outcomes control has little reason to exist, and its worth as a system of patient compensation can be reexamined. It is within the framework of PSRO that other systems of compensation of the injured patient can be considered and developed--systems hopefully more just and more efficient than malpractice. This is the greatest impact PSRO will have on malpractice. It is, of course, a long-term process, and one which will not produce immediate results. In fact, the role of PSRO in effecting a change in patient compensation may never be recognized directly. It is only within the existence of a working system controlling the quality of outcomes of medical care that the injustices of the malpractice system can be righted and alternatives to that system can be considered.

Defensive Medicine↗
PubMed1982

An automated PSRO-utilization review system.

A set of computer programs collects, processes, and reports Professional Standards Review Organization (PSRO) and utilization data for all patients at the Miami Heart Institute. They help reduce the time spent by physicians in PSRO and utilization review activities and ease the clerical work load required to comply with rules and guidelines. Daily printed reports provide attending physicians with their patient census and inform them of the next scheduled PSRO review dates for each of their patients. Reports are produced also for the Utilization Review Committee and the Institute's PSRO office. This set of programs is part of a comprehensive automated hospital information system and has been designed to respond rapidly to the frequent changes in regulations and policies dictated by the administering agency. The PSRO subsystem had been in uninterrupted operation for over 6 years and has mitigated escalating clerical and, therefore, health care costs. Physicians' acceptance of this subsystem had been adequate; however, developmental and maintenance costs are high in comparison with other applications within the hospital information system. This article describes the methodology used in complying with PSRO requirements. It does not attempt to evaluate the impact of PSRO on quality of care or length of hospital stay.

Cardiac Care Facilities↗
PubMed1975

Private Initiative in PSRO.

Private initiative in PSRO (Pl) is a privately funded joint effort by five major professional organizations to influence the implementation of PSRO on behalf of the public interest. Working with five PSRO's, PI is testing a form of concurrent quality assurance and its effect on the immediate outcomes of hospital care. The project also promotes and evaluates participation in local PSRO's by representatives of the general public. The operating costs of PSRO's and their impact on hospital utilization and reimbursements by Medicare and Medicaid are being prospectively determined. A central issue addressed by PI is growing encroachment by the central administration of PSRO on private medicine's traditional responsibility for assuring the quality of care. PI seeks improved means of rendering a satisfactory public accounting in quality assurance as an alternative to federal regulation of this elemental professional function.

Community Participation↗
PubMed1980

Optimal investigation policies under selected PSRO procedures.

This article presents a methodology for utilization review which aids the local Professional Standards Review Organization (PSRO) in selecting optimal timing of Concurrent Stay certification by diagnosis. This procedure is accomplished by modeling patients' admissions, inpatients stays and discharges for each diagnosis as a stochastic process which is audited under the PSRO by three utilization review techniques: preadmission, concurrent and retrospective review. The timing of concurrent stay certification is determined so that the maximum benefits are derived for the utilization review cost expanded. The methodology presented here is a tool to aid local PSRO management in determining the most cost-beneficial utilization review process to utilized in their jurisdiction. It is not an attempt to demonstrate the effectiveness of our utilization review policy over another in general. On the contrary, while the model is generalizable to every PSRO, the utilization review policies resulting from any application are situation-specific. The major contributions of this article are new insight into modeling the utilization review process and the provision of a methodology for which computer programs exist and are readily available to any PSRO that should desire to determine its utilization review procedure in this cost-benefit framework. In order to apply the model it is necessary that certain parameters specific to the application site be estimated or assumed. Exact procedures to aid the PSRO in parameter estimation is the subject of current investigation.

Concurrent Review↗
PubMed1976

The challenge: PSRO and optometry.

Professional Standards Review Organizations (PSRO) will be reviewing services rendered under Medicare/Medicaid and Maternal and Child Health. The United States has been divided into 203 PSRO areas. In states with three or more PSROs, a statewide Professional Standards Review Council will be set up. A national Professional Standards Review Council advises the Secretary of HEW and Congress on the progress of the PSRO program. Norms, criteria and standards will be used in the PSRO review process. It is hoped that the PSRO system will be able to improve the quality and cost effectiveness of health care being paid for by the Federal government.

Humans↗
PubMed1975

The PSRO hospital review system.

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.

Evaluation Studies as Topic↗
PubMed1978

Concurrent quality assurance in hospital care. Report of a study by Private Initiative in PSRO.

To test the feasibility and effects of incorporating concurrent quality assurance (CQA) into the concurrent utilization reviews required by PSRO's, adherence to essential criteria of medical care and attainment of expected immediate outcomes were monitored prospectively in 5604 cases of seven conditions in 24 experimental and 26 control hospitals in five PSRO areas. CQA was not consistently associated with improved documentation in records, but was associated with slightly better adherence to treatment criteria in all five PSRO areas (P less than 0.03). Adherence to pooled documentation or treatment criteria was unrelated to outcomes. However, failure to adhere to disease-specific scientifically validated treatment criteria was associated with unsatisfactory outcomes in bacterial pneumonia (P less than 0.01) and acute myocardial infarction (P less than 0.02). CQA was professionally acceptable, technically feasible and compatible with PSRO reviews. Given adequate physician support, CQA can produce slightly greater adherence to treatment criteria. If the criteria are valid, adherence may lead to improved immediate outcomes in some diseases.

Adult↗
PubMed1981

Professional standards review; Professional Standards Review Organization (PSRO)--Health Care Financing Administration. Interim final regulation with a comment period.

This interim final rule is required to conform current regulations to certain provisions of the Omnibus Reconciliation Act of 1980 (Pub. L. 96-499) and the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35). To conform with current statutory authority, this rule makes technical changes to Parts 431, 432, 433, 456, 462, 463, 466, 473, 478, and 480 of Chapter 42 of the Code of Federal REgulations. The Omnibus Reconciliation Act of 1980 (Pub. L. 96-499) made several adjustments to the PSRO program. In conformance with that Act, this rule changes PSRO membership and advisory group requirements. The Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35) has further modified the PSRO program. In conformance with that Act, this rule changes the agreement requirements between HCFA and each PSRO. Accordingly, such agreements may be for any period not to exceed 12 months (42 CFR 462.11(a)(2)), and the procedures for termination or non-renewal of the agreement are modified.

Professional Review Organizations↗
PubMed1979

Analysis of variations in hospital use by Medicare patients in PSRO areas, 1974-1977.

A study of the use of short-stay hospitals in PSRO areas by Medicare enrollees aged 65 and over for the period 1974 through 1977 revealed that discharge rates increased, average length of stay (ALOS) decreased, and days-of-care rates remained relatively constant in nearly all of the PSRO areas. The data show large variations in hospital use in PSRO areas within States and HEW regions, and suggest that factors within the area are critical determinants of hospital utilization. This study presents important implications for PSRO program policy for it suggests that factors other than physician and hospital behavior should also be considered when setting objectives for reducing misutilization and improving the quality of health care.

Aged↗
PubMed1979

PSRO impact: are the statements valid?

The generation of PSRO impact statements cannot simply be a "fill in the formula" routine. A health care system is not a simple environment, and narrow approaches to documenting change usually will not suffice. Instead, one would hope that future PSRO impact studies will take into consideration at least the concerns discussed here, as well as many others. As demonstrated in the New Mexico PSRO experiment, PSROs may not be able to demonstrate cost savings given the enormity and fragmentation of the health care environment. Such a conclusion should not result in a declaration of the PSRO program's failure but, instead, should serve to redirect the program's emphasis toward quality assurance, for which even the OPEL study noted impact.

Accounting↗
PubMed1975

PSRO and quality assurance: what is the occupational therapist's role?

This article highlights the characteristics of the PSRO review process, looks briefly at the variety of patient care evaluation procedures and enumerates the ways in which occupational therapists can participate. There are two major steps the occupational therapists can take. The first is done on an individual or staff level. The second, involving a series of ongoing contacts, needs to be organized through a state or local occupational therapy association. Individual participation starts in your own service area with chart audit of the quality of occupational therapy care. The audit is based on criteria developed or adapted in the occupational therapy department. There are now many ways to gain the skills necessary for such a project. They are listed in the article. Occupational therapists can have input into the PSRO program through a PSRO committee of their state or local occupational therapy association. Selected representatives of the occupational therapy affiliates should contact all PSROs in their state. The area in which occupational therapists can interact with the PSRO are described.

Humans↗
PubMed1976

Orphan data and the unclosed loop: a dilemma in PSRO and medical audit.

The experience of the Utah Professional Review Organization in conducting medical audit as a PSRO prototype, and later a PSRO, suggests that usage of diagnosis-oriented process audits, using criteria similar to those supplied by the American Medical Association, will result in accumulation of vast amounts of unusable data. Even studies based on outcome data may fail to change physician behavior substantially because of communication difficulties between the PSRO or hospital conducting the evaluation and the physicians subject to the audit. UPRO's experience suggests that medical audit can be made more effective if it employs a special study format that looks at a particular element of care, selected for its importance to patient welfare and potential for improvement. The study should be based on criteria solidly validated by clinical research, and should involve a direct and personal interaction between the review body and the physician being reviewed.

Education, Medical, Continuing↗
PubMed1976

9. PSRO review of long-term care utilization and quality.

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.

Government Agencies↗
PubMed1980

Health Care Financing Administration--Professional Standards Review; redesignation of PSRO areas in California. Final regulation.

This regulation redesignates Professional Standards Review Organization (PSRO) areas in California in order to combine PSRO Areas XIX and XXIII. This redesignation will facilitate initiation of PSRO activity in the currently uncovered area of Los Angeles, California, formerly designated as Area XIX. In addition, the redesignation results in a higher degree of congruence with the Health Service Areas (HSA) designations and in more effective coordination with Medicare intermediaries and carriers and Medicaid fiscal agents.

California↗
PubMed1976

PSRO: current status of the professional standards review organization program.

Since Public Law 92-603 was enacted in October 1972 considerable progress has been made in the establishment of Professional Standards Review Organizations (PSROs) for the purpose of determining the necessity, appropriateness, and quality of medical care provided beneficiaries of the major programs authorized in the Social Security Act. Sixty-five conditional PSROs are implementing review in acute care hospitals in their geographic area, and 55 planning groups are developing plans to qualify for conditional PSRO designation. The PSRO hospital review system is based on three interrelated review mechanisms. These are concurrent review, which includes admission certification, and continued stay review through discharge; medical care evaluation studies; and analysis of hospital, practitioner, and patient profiles. This article describes the review system in some detail and the potential opportunities the PSRO program offers to occupational therapists.

Hospitals↗
PubMed1975

PSRO-future impact on community mental health centers.

In November 1972 Congress passed P.L. 92-603 creating Professional Standards Review Organizations (PSROs) to involve practicing physicians and other health care professionals in the ongoing review and evaluation of health care services funded through Medicare, Medicaid, and maternal and child health programs. This paper examines the requirements and components of the PSRO program, the mandate for nonphysician peer review, and future implications for mental health facilities including community mental health centers. With the eventual review of community mental health centers by PSRO's, centers must begin plans for implementing review programs that evaluate the necessity, the quality, and the cost of services.

Community Mental Health Services↗