Harris M D, McDonald M
Home Healthc Nurse. 1991 Jan-Feb;9(1):37-42. doi: 10.1097/00004045-199101000-00012.
The PRO process is just one of the many reviews that HHAs are subjected to at any given time. On a practical level, HHA should incorporate PRO criteria and GQSs into its QA program. At present, there is no mechanism in place for denial of payment for substandard care, although proposed regulations were published in the January 18, 1989 Federal Register. Medicare certification, and therefore payment, could be lost if the facility or HHA were sanctioned. The Medicare law requires PROs to coordinate their activities with other review organizations. HCFA, however, has not established procedures for providing reports from fiscal intermediaries and PROs to the state survey agencies or coordinating state surveys with PRO reviews. HHAs should have structure and process criteria in place (either manual or computerized) to identify selected records for review. This enables the agency to monitor its internal quality assurance activities so that it has confidence that the GQSs will be met when reviewed by external agencies, including the PRO. This internal monitoring will also enable the agency to document patient outcomes. This is an important aspect of the evaluation process, since the emphasis of certification and accreditation programs and site visits will be focused on patient outcomes in the 1990s.
专业评审（PRO）流程只是家庭健康机构（HHA）在任何特定时间所接受的众多评审之一。在实际层面，HHA应将PRO标准和通用质量标准（GQS）纳入其质量保证计划。目前，对于因护理不达标而拒绝付款尚无相关机制，尽管1989年1月18日的《联邦公报》公布了相关拟议法规。如果机构或HHA受到制裁，可能会失去医疗保险认证，进而失去付款资格。医疗保险法要求专业评审机构将其活动与其他评审组织进行协调。然而，医疗保健财务管理局（HCFA）尚未制定相关程序，以便向州调查机构提供来自财务中介机构和专业评审机构的报告，或协调州调查与专业评审机构的评审工作。HHA应具备适当的结构和流程标准（无论是手动还是计算机化），以识别选定的记录进行评审。这使机构能够监控其内部质量保证活动，从而确信在包括专业评审机构在内的外部机构进行评审时能够达到通用质量标准。这种内部监控还将使机构能够记录患者的治疗结果。这是评估过程的一个重要方面，因为在20世纪90年代，认证和认可计划以及实地考察的重点将集中在患者治疗结果上。
