Biomaterial Database

Whither the PRO? Analysis of the effectiveness of three Medicare peer review organizations in a Florida hospital. 1995

B M Fleegler, and M Wolk, and J McCarville

Management Engineering, Sarasota Memorial Hospital, USA.

The objective of this retrospective study was to evaluate the effectiveness of a peer review organization (PRO) on patient mortality rate in a not-for-profit, 988-bed community hospital in Florida. The number of deaths per hospital discharge (mortality) was compared prior to the Professional Foundation for Health Care (PFHC) holding the contract as the Medicare PRO (1983), during two years in which the PRO was fully active (1990 and 1991), during the year limited PRO activities were conducted (1992), and when PRO activities were again fully expanded (1993). All Medicare hospital discharges, including deaths, were included from January through May during 1983, 1990 through 1993. There was no intervention. Patient mortality as a determinant of PRO effectiveness was evaluated prior to the PRO, during a portion of the years the PFHC held the contract as the Medicare PRO, and an identical time period one year later with limited PRO review and again the following year when full reviews returned. The number of deaths did not change significantly. Mandated peer reviews of care to inpatient hospital Medicare beneficiaries did not significantly improve health care as measured by mortality.

UI	MeSH Term	Description	Entries
D010351	Patient Discharge	The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities.	Discharge Planning,Discharge Plannings,Discharge, Patient,Discharges, Patient,Patient Discharges,Planning, Discharge,Plannings, Discharge
D010380	Peer Review	An organized procedure carried out by a select committee of professionals in evaluating the performance of other professionals in meeting the standards of their specialty. Review by peers is used by editors in the evaluation of articles and other papers submitted for publication. Peer review is used also in the evaluation of grant applications. It is applied also in evaluating the quality of health care provided to patients.	Review, Peer,Peer Reviews,Reviews, Peer
D011366	Professional Review Organizations	Organizations representing designated geographic areas which have contracts under the PRO program to review the medical necessity, appropriateness, quality, and cost-effectiveness of care received by Medicare beneficiaries. Peer Review Improvement Act, PL 97-248, 1982.	PRO Professional Review Organizations,PSRO,Peer Review Organizations,Professional Standards Review Organizations,Utilization and Quality Control Peer Review Organizations,Organizations, Peer Review,Organizations, Professional Review,Review Organizations, Professional,Organization, Peer Review,Organization, Professional Review,Peer Review Organization,Professional Review Organization
D005431	Florida	State bounded on east by the Atlantic Ocean, on the south by the Gulf of Mexico, on the west by Alabama and on the north by Alabama and Georgia.
D006278	Medicare	Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)	Health Insurance for Aged and Disabled, Title 18,Insurance, Health, for Aged and Disabled,Health Insurance for Aged, Disabled, Title 18,Health Insurance for Aged, Title 18
D006764	Hospitals, Community	Institutions with permanent facilities and organized medical staff which provide the full range of hospital services primarily to a neighborhood area.	Community Hospital,Community Hospitals,Hospital, Community
D006788	Hospitals, Voluntary	Private, not-for-profit hospitals that are autonomous, self-established, and self-supported.	Hospitals, Private, Not-for-Profit,Hospitals Privates, Not-for-Profit,Not-for-Profit Hospitals Private,Not-for-Profit Hospitals Privates,Private, Not-for-Profit Hospitals,Voluntary Hospitals,Hospital, Voluntary,Hospitals Private, Not-for-Profit,Hospitals Privates, Not for Profit,Not for Profit Hospitals Private,Not for Profit Hospitals Privates,Private, Not for Profit Hospitals,Privates, Not-for-Profit Hospitals,Voluntary Hospital
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189	Retrospective Studies	Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.	Retrospective Study,Studies, Retrospective,Study, Retrospective
D014481	United States	A country in NORTH AMERICA between CANADA and MEXICO.