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

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.