Peer Review Organizations: Scientific Challenges in HCFA's Health Care Quality Improvement Initiative

Agency for Health Care Policy and Research. "Report to Congress: The Feasibility of Linking Research-Related Data Bases to Federal and Non-Federal Medical Administrative Data Bases." AHCPR Publication No. 91-0003, Washington, DC, 1991 .

"AMA Backs Continued Funding for PSROs." American Medical News 23 (5 September 1980): 2

. Andersen, T.F. , and G. Mooney. "Challenges Facing Modern Health Care." In The Challenges of Medical Practice Variations. Edited by T. F. Andersen and G. Mooney. London: Macmillan Press Scientific and Medical, 1990.

Anthony, C.R. "Policymaking for Health Care Delivery: 1990 Review and Prospects for 1991." In Health Care Delivery: Current Issues and the Public Policy Debate. Health Policy Annual I. Edited by R. Kaufman, J. Naughton, M. Osterweis, and E. Rubin. Washington, DC: Association of Academic Health Centers, 1991 .

"Anxious PRO Trade Group Asks Rewrite of Performance Report." Medical Utilization Review 18, no. 6 (1990): 3

. Berwick, D.M. , and D.L. Wald. "Hospital Leaders' Opinions of the HCFA Mortality Data." Journal of the American Medical Association 263, no. 2 (12 January 1990): 247-49.

Billings, J. , and D. Eddy. "Physician Decision Making Limited by Medical Evidence." Business and Health 5, no. 1 (November 1987): 23, 26-28

. Caper, P. "Population-Based Measures of the Quality of Medical Care." In Health Care Quality Management for the 21st Century. Edited by J. B. Couch. Tampa, FL: Hillsboro Printing, 1991.

Christensen, S. "Did 1980's Legislation Slow Medicare Spending?" Health Affairs 10, no. 2 (Summer 1991): 135-42

. Dans, P.E. , J.P. Weiner , and S.E. Otter. "Peer Review Organizations: Promises and Potential Pitfalls." New England Journal of Medicine 313, no. 18 (31 October 1985): 1131-37.

Davis, D.A. , M.A. Thomson , A.D. Oxman , and B. Haynes. "Evidence for the Effectiveness of CME." Journal of the American Medical Association 268, no. 9 (2 September 1992): 1111-17

. Donabedian, A. "Reflections on the Effectiveness of Quality Assurance." In Striving for Quality in Health Care: An Inquiry into Policy and Practice. Edited by R. H. Palmer, A. Donabedian, and G. J. Povar. Ann Arbor, MI: Health Administration Press , 1991.

Eisenberg, J.M. Doctors' Decisions and the Cost of Medical Care: The Reasons for Doctors' Practice Patterns and Ways to Change Them Ann Arbor, MI : Health Administration Press Perspectives , 1986

. "Feds 'Enthusiastic' on PRO Changes, Congressional Hearings Predicted." Medical Utilization Review 18, no. 6 (1990): 1-2

. Fink, A. , E.M. Yano , and R.H. Brook. "The Condition of the Literature on Differences in Hospital Mortality." Medical Care 27, no. 4 (April 1989): 315-36

. Fisher, E.S. , J.A. Baron , D.J. Malenka , J. Barrett , and T.A. Bubolz. "Overcoming Potential Pitfalls in the Use of Medicare Data for Epidemiologic Research." American Journal of Public Health 80, no. 12(December 1990): 1487-90

. Fisher, E.S. , J.A. Baron , D.J. Malenka , J.A. Barrett , W.D. Kniffin , F.S. Whaley , and T.A. Bubolz. "Hip Fracture Incidence and Mortality in New England." Epidemiology 2, no. 2(March 1991): 116-22

. Fisher, E.S. , F.S. Whaley , W.M. Krushat , D.J. Malenka , C. Fleming , J.A. Baron , and D.C. Hsia. "The Accuracy of Medicare's Hospital Claims Data: Progress Has Been Made, But Problems Remain." American Journal of Public Health 82, no. 2 (1992): 243-48

. Fleming, C. , E.S. Fisher , C-H. Chang , T.A. Bubolz , and D.J. Malenka. "Studying Outcomes and Hospital Utilization in the Elderly: The Advantages of a Merged Data Base for Medicare and Veteran Affairs Hospitals." Medical Care 30, no. 5 (May 1992): 377-91

. "Ford Signs PSRO, Medicare Changes." American Medical News 19 (12 January 1976): 1

. Goldberg, K.C. , A.J. Hartz , S.J. Jacobsen , H. Krakauer , and A.A. Rimm. "Racial and Community Factors Influencing Coronary Artery Bypass Graft Surgery Rates for All 1986 Medicare Patients." Journal of the American Medical Association 267, no. 11 (18 March 1992): 1473-77.

Grimaldi, P.L. , and J.A. Micheletti . "PRO Objectives and Quality Criteria." In Hospital Organization and Management Text and Readings. 4th ed. Edited by K. Darr and J. S. Rakich. Owings Mills, MD: National Health Publishing, 1989.

Hartz, A.J. , M.S. Gottlieb , E.M. Kuhn , and A.A. Rimm. "The Relationship between Adjusted Hospital Mortality and the Results of Peer Review." Health Services Research 27, no. 6 ( 1993): 765-77

. Haynes, R.B. , D.A. Davis , A. McKibbon , and P. Tugwell. "A Critical Appraisal of the Efficacy of Continuing Medical Education." Journal of the American Medical Association 251, no. 1 (6 January 1984): 61-64

. "HCFA Backing Off from Medicare Automated Review Plan." Medical Utilization Review 20, no. 8(1992): 4

. "HCFA Circulating UCDS Findings." Medical Utilization Review 20, no. 9 ( 1992): 2-3

. Health Care Financing Administration. "First Scope of Work." Washington, DC: Government Printing Office, 1985.

Health Care Financing Administration. "Second Scope of Work." Washington, DC: Government Printing Office, 1987.

Health Care Financing Administration. "Third Scope of Work." Washington, DC: Government Printing Office, 1989.

Health Care Financing Administration. "Fourth Scope of Work (Draft)." Washington, DC: Government Printing Office, August 26, 1991.

Health Care Financing Administration. "Fourth Scope of Work (Draft)." Washington, DC: Government Printing Office, October 10, 1992a.

Health Care Financing Administration. "Statement of Work for the Clinical Data Abstraction Center." Department of Health and Human Services Washington, DC: Government Printing Office, 1992b.

Hicks, N. "Nation's Doctors Move to Police Medical Care." New York Times (28 October 1973): 1, 52

. Iezzoni, L.I. , A.S. Ash , G.A. Coffman , and M.A. Moskowitz. "Predicting In-Hospital Mortality: A Comparison of Severity Measurement Approaches." Medical Care 30, no. 4 (April 1992): 347-59

. Jencks, S.F. , and G.R. Wilensky. "The Health Care Quality Improvement Initiative : A New Approach to Quality Assurance in Medicare." Journal of the American Medical Association 268, no. 7 (19 August 1992): 900-903

. Jones, S.B. "The Health Policy Landscape: Shifting Perspectives on Costs, Quality, and Access." In Health Care Delivery: Current Issues and the Public Policy Debate. Health Policy Annual I. Edited by R. Kaufman, J. Naughton, M. Osterweis, and E. Rubin. Washington, DC: Association of Academic Health Centers, 1991 .

Knowles, M. Modern Practices in Adult Education New York: Press, 1970.

Krakauer, H. , and R.C. Bailey. "Epidemiologic Oversight of the Medical Care Provided to Medicare Beneficiaries." Statistics in Medicine 10, no. 4 (April 1991 ): 521-40

. Krakauer, H. , R.C. Bailey , K.J. Skellan , J.D. Stewart , A.J. Hartz , E.M. Kuhn , and A.A. Rimm. "Evaluation of the HCFA Model for the Analysis of Mortality following Hospitalization." Health Services Research 27, no. 3 (1992): 317-35.

Lohr, K.N. "Quality of Health Care: An Introduction to Critical Definitions, Concepts, Principles, and Practicalities." In Striving for Quality in Health Care: An Inquiry into Policy and Practice. Edited by R. H. Palmer, A. Donabedian, and G. J. Povar. Ann Arbor, MI : Health Administration Press, 1991.

—. "The Utilization and Quality Control Peer Review Organization Program." In Medicare: A Strategy for Quality Assurance. Institute of Medicine. Vol. I. Edited by K. N. Lohr. Washington, DC: National Academy Press, 1990.

Lohr, K.N. , and A.J. Walker. "The Utilization and Quality Control Peer Review Organization Program." In Medicare: A Strategy for Quality Assurance. Institute of Medicine. Vol. II. Edited by K. N. Lohr. Washington, DC: National Academy Press, 1990.

Lyons, R.D. "Medicare Study in Senate Seeks Urgent Reforms." New York Times (9 February 1970): 14

. —. "Program to Aid Kidney Victims Faces Millions in Excess Costs." New York Times (11 January 1973): 10

. Michels, K.A. "Health Care Financing Administration—Structure and Mission." Journal of the American Association of Nurse Anesthesiologists 59, no. 2 (April 1991 ): 102-105

. "Most State Societies Plan PSRO Roles." American Medical News 16 (23 July 1973): 3

. Nash, D.B. "Is the Quality Cart before the Horse?" Journal of the American Medical Association 268, no. 7 (19 August 1992): 917-18

. "New Directions for the PRO Program." American Medical Peer Review Association Review 9, no. 1 (1992): 1-5

. "New PRO Performance Statistics Show Wide (Unexplained) Variations." Medical Utilization Review 17, no: 22 (1989): 1-2

. Oberman, L. "PRO Report Card: Critics Question if Declining Sanctions Are Sign of Success." American Medical News 3 (7 December 1992): 33

. Orsolits, M. , and F. Abbey. "Impact of Peer Review Organizations on Hospitals." In Quality Assurance in Hospitals: Strategy for Assessment and Implementation. 2nd ed. Edited by N. O. Graham. Rockville, MD: Aspen Publishers, 1990.

Palmer, R.H. "Considerations in Defining Quality of Health Care." In Striving for Quality in Health Care: An Inquiry into Policy and Practice. Edited by R. H. Palmer, A. Donabedian, and G. J. Povar. Ann Arbor, MI: Health Administration Press, 1991.

Pates, R.D. , M.T. Lundberg , C. Boymel , A. Webber , G. Wright , R.P. Gressard , P.M. Simpson , G.W. Lynch , and D.J. Ballard. "Creation of Comprehensive Population-Based Medicare Database by Linkage of Data from Four Professional Review Organizations." Proceedings of the Annual Meeting of the American Medical Review Research Center. Washington, DC, November 17, 1992.

Petrillo, M.K. , and P. Elstein. "Educational Feedback: The New Era for PROs, Providers and HCFA." Proceedings of the Eighth Annual Research Symposium of the American Medical Review Research Center. Washington, DC, May 20-21, 1993

. Poses, R.M. , and W.R. Smith. "Measuring Health Care Quality" (Letter to the Editor). Journal of the American Medical Association 269, no. 1(6 January 1993): 48

. "PRO Program Performance Data Suggest only Marginal Impact." Medical Utilization Review 18, no. 5 (1990): 1

. "PROs Livid over HCFA's Plan for Automated Medicare Review." Medical Utilization Review 20, no. 3 (1992): 1-2

. "Professional Standards Review—Medicare and Medicaid: Section-by-Section Summary of Amendment." Congressional Review (25 January 1972): 1019-20

. "Revamp Medicare Quality System—IOM." Medical Utilization Review 18, no. 3 (1990): 1

. Rogers, E.M. "Diffusion of Innovations: An Overview." In Diffusion of Innovations. 3rd ed. Edited by E. M. Rogers. New York: The Free Press , 1983.

Roos, N.P. , and L.L. Roos. "Surgical Rate Variations: Do They Reflect the Health or Socioeconomic Characteristics of the Population?" Medical Care 20, no. 9 (1982): 945-58

. Rubin, H.R. , W.H. Rogers , K.L. Kahn , L.V. Rubenstein , and R.H. Brook. "Watching the Doctor-Watchers: How Well Do Peer Review Organization Methods Detect Hospital Care Quality Problems?" Journal of the American Medical Association 267, no. 17 (6 May 1992): 2349-54

. "Shift in PSRO Control Urged." American Medical News 16 (June 4, 1973): 1, 3

. Sloan, F.A. , M.A. Morrisey , and J. Valvona. "Effects of the Medicare Prospective Payment System on Hospital Cost Containment: An Early Appraisal." Milbank Quarterly 66, no. 2 ( 1988): 191-220

. Smits, H.L. "The PSRO in Perspective." New England Journal of Medicine 305, no. 5 (30 July 1981): 253-59

. Soumerai, S.B. , and J. Avorn. "Principles of Educational Outreach ('Academic Detailing') to Improve Clinical Decision Making." Journal of the American Medical Association 263, no. 4 (26 January 1990): 549-56

. Stacey, J. "PSRO Leaders Are Dismayed at Privacy Decision, Fund Cuts." American Medical News 1 ( 1979): 28

. Sullivan, L.W. , and W. Toby. Medicare Hospital Information, 1988, 1989, 1990: Technical Supplement Vol 55. Washington, DC: Government Printing Office, 1992.

"Three Lobby Groups Warn against Rapid Change in PRO Program." Medical Utilization Review 20, no. 11 (1992): 2-3

. Thomas, J.W. , J.J. Holloway , and K.E. Guire. "Validating Risk-Adjusted Mortality as an Indicator for Quality of Care." Inquiry 30 (Spring 1993): 6-22

. "U.S. Senators, Lobby Groups Warn HCFA against PRO Overhaul." Medical Utilization Review 20, no. 7 (1992): 1-2

. Wennberg, J.E. , L. Blowers , R. Parker , and A.M. Gittelsohn . "Changes in Tonsillectomy Rates Associated with Feedback and Review." Pediatrics 59, no. 6 (June 1977): 821-26.

Wennberg, J.E. , and A.M. Gittelsohn , "Small Area Variations in Health Care Delivery." Science 182, (14 December 1973): 1102-1108

. Wennberg, J.E. , and A.M. Gittlesohn . "Variations in Medical Care among Small Areas." Scientific American 246, (January 1982): 120-134

. Wennberg, J.E. , A.G. Mulley, Jr. , D. Hanley , R.P. Timothy , F.J. Fowler , N.P. Roos , M.J. Barry , K. McPherson , E.R. Greenberg , D. Soule , R. Bubolz , E. Fisher , and D. Malenka. "An Assessment of Prostatectomy for Benign Urinary Tract Obstruction: Geographic Variations and the Evaluation of Medical Care Outcomes." Journal of the American Medical Association 259, no. 20 (May 1988 ): 3027-30

. Winkler, J.D. , K.N. Lohr , and R.H. Brook. "Persuasive Communication and Medical Technology Assessment." Archives of Internal Medicine 145, (February (1985): 314-17

. Winslow, C.M. , D.H. Solomon , M.R. Chassin , J. Kosecoff , N.J. Merrick , and R.H. Brook. "The Appropriateness of Carotid Endarterectomy." New England Journal of Medicine 318, no. 12 (24 March 1988): 721-27.