PSRO: current status of the professional standards review organization program

Area of Science:

• Health Services Research
• Medical Quality Assurance
• Public Health Policy

Background:

• Public Law 92-603, enacted in October 1972, mandated the creation of Professional Standards Review Organizations (PSROs).
• PSROs aim to ensure the necessity, appropriateness, and quality of medical care for beneficiaries of major Social Security Act programs.
• Significant progress has been made in establishing PSROs, with many actively implementing review systems.

Purpose of the Study:

• To describe the established PSRO hospital review system in detail.
• To outline the potential opportunities the PSRO program presents for occupational therapists.
• To inform stakeholders about the advancements and applications of PSROs in healthcare quality management.

Main Methods:

• Description of the PSRO hospital review system, a multi-faceted approach to quality assurance.
• Explanation of concurrent review, including admission certification and continued stay review.
• Discussion of medical care evaluation studies and the analysis of hospital, practitioner, and patient profiles.

Main Results:

• Sixty-five conditional PSROs are currently conducting reviews in acute care hospitals.
• Fifty-five planning groups are in the process of developing plans to achieve conditional PSRO designation.
• The PSRO review system is operational and evolving, with established mechanisms for monitoring healthcare delivery.

Conclusions:

• The PSRO program represents a significant advancement in monitoring and improving the quality of medical care.
• The described review mechanisms provide a framework for ensuring healthcare services meet established standards.
• Occupational therapists can potentially leverage the PSRO framework to enhance their role in patient care and outcomes.