Dans P E, Weiner J P, Otter S E
N Engl J Med. 1985 Oct 31;313(18):1131-7. doi: 10.1056/NEJM198510313131806.
The Health Care Financing Administration has contracted with 54 peer review organizations (PROs) to monitor hospital use and quality of care for Medicare patients. PROs promised reductions in readmissions, in "unnecessary" admissions or invasive procedures, and in "avoidable" mortality and morbidity. A review of contract summaries for 49 PROs revealed wide variations in reduction targets. In attempting to meet their goals, PROs will encounter numerous potential pitfalls, including inaccurate and incomplete discharge data, inadequate descriptors for the variety of patients and physicians' management plans, honest differences in judgments about patient care, and limited research on the criteria used to set their reduction targets as well as the means to accomplish them. Despite having more explicit quality-of-care objectives, PROs, like PSROs (professional standards review organizations) before them, are more likely to be seen as agents of cost containment than of quality assurance. Both their credibility and their effectiveness might be enhanced if an expert panel of clinicians and health services researchers were established to help them set and achieve reasonable objectives for quality of care.
医疗保健财务管理局已与54个同行评审组织（PROs）签约，以监测医疗保险患者的医院使用情况和护理质量。PROs承诺减少再入院率、“不必要的”入院或侵入性手术，以及“可避免的”死亡率和发病率。对49个PROs的合同摘要进行审查后发现，减少目标存在很大差异。在试图实现其目标时，PROs将遇到许多潜在的陷阱，包括出院数据不准确和不完整、对各类患者和医生管理计划的描述不充分、对患者护理判断的真实差异，以及关于用于设定其减少目标的标准及其实现手段的研究有限。尽管有更明确的护理质量目标，但与之前的专业标准评审组织（PSROs）一样，PROs更有可能被视为成本控制的代理，而不是质量保证的代理。如果成立一个由临床医生和卫生服务研究人员组成的专家小组来帮助他们设定并实现合理的护理质量目标，那么他们的可信度和有效性可能都会得到提高。
