Butman S M
Department of Medicine, University of Arizona, Tucson.
Cathet Cardiovasc Diagn. 1990 Dec;21(4):227-32. doi: 10.1002/ccd.1810210404.
The Health Care Financing Administration has contracted with state peer review organizations (PROs) in its effort to assure the quality of services and eliminate unreasonable and inappropriate care provided Medicare beneficiaries. By law, each state PRO must select 10 procedures for precertification. Coronary angioplasty has been chosen by 45 PROs for precertification and criteria in each state were developed with the advice of local physicians. This report describes the findings of a survey of these precertification criteria in an effort to determine their variability and to compare the PRO criteria to published national criteria created by expert panels. Current precertification criteria of Medicare beneficiaries show significant variability in the priorities and the clinical practice of cardiologists in performing coronary angioplasty, despite established and published guidelines for its safe and efficacious use. It is likely that the establishment of locally based criteria for coronary angioplasty will be geographically uneven and probably have a less than expected impact on the care provided to Medicare beneficiaries.
医疗保健财务管理局已与各州的同行评审组织（PROs）签约，以确保服务质量，并消除为医疗保险受益人提供的不合理和不适当的护理。根据法律规定，每个州的PRO必须选择10种程序进行预认证。45个PRO已选择冠状动脉成形术进行预认证，并且每个州的标准都是在当地医生的建议下制定的。本报告描述了对这些预认证标准的调查结果，旨在确定其可变性，并将PRO标准与专家小组制定的已发布的国家标准进行比较。尽管已经有关于冠状动脉成形术安全有效使用的既定和发布的指南，但医疗保险受益人的当前预认证标准在心脏病专家进行冠状动脉成形术的优先事项和临床实践方面仍存在显著差异。很可能基于当地的冠状动脉成形术标准的建立在地理上会不均衡，并且可能对为医疗保险受益人提供的护理产生低于预期的影响。
