9. PSRO review of long-term care utilization and quality

Area of Science:

• Healthcare quality assurance
• Health services research
• Long-term care administration

Background:

• Professional Standards Review Organizations (PSROs) require comprehensive data for long-term care institutional review.
• The National Professional Standards Review Council has approved a general framework for PSRO long-term care review.

Purpose of the Study:

• To outline the proposed PSRO long-term care review system.
• To describe the Bureau of Quality Assurance's plan for testing and refining review methodologies.
• To assess the feasibility, costs, and impact on quality of care of different review approaches.

Main Methods:

• The Bureau of Quality Assurance will initiate demonstration projects to test various acceptable approaches to long-term care review.
• A general outline of the proposed PSRO long-term care review system is presented.
• The study acknowledges the evolutionary state of long-term care review within PSROs.

Main Results:

• The Bureau of Quality Assurance will not mandate a single uniform methodology for PSRO use during the initial phase.
• Demonstration projects will provide data to assess the effectiveness of different review strategies.
• The fundamental elements of long-term care review are expected to remain consistent.

Conclusions:

• A flexible, evidence-based approach to PSRO long-term care review is being developed.
• Demonstrations are crucial for refining methodologies and ensuring quality of care improvements.
• The Bureau of Quality Assurance aims to balance standardization with adaptability in PSRO review processes.