title: Primary causes of medical instability of Medicare patients at discharge 1990-1991.
abstract: BACKGROUND
  HCFA-sponsored Peer Review Organizations nationwide have been criticized by organized medicine, Medicare beneficiaries and interested Congressional parties for being punitive without exploiting educational opportunities garnered through their massive data collection capabilities. Until now this data has been poorly analyzed and has not been adequately utilized as a positive motivational tool.
  
  
  METHODS
  HCFA has developed, with the cooperation of the medical community, six generic screens for Peer Review Organizations to utilize when evaluating quality care provided Medicare beneficiaries in an acute care setting. Through the sheer volume of cases seen, significant inpatient information can be obtained that cannot be duplicated in any other epidemiological endeavor. Line item discrepancies can be further studied through small-area-analysis to determine "who" as well as "what" may be the problem.
  
  
  RESULTS
  By compiling and reviewing data in a systematic manner over two years (1990-1991), the Alabama Quality Assurance Foundation (AQAF) has singled out problems with patient medical stability at discharge as the predominant concern for care providers and reviewers alike.
  
  
  CONCLUSIONS
  Having determined the primary problem in rendering quality care in a Prospective Payment System to Medicare beneficiaries lies in premature discharges, subsequent small-area-analysis further narrows the focus of concerned individuals. Hopefully, practitioners and providers alike will act on their own initiative in correcting this problem. Follow-up review will be utilized to assure this self-corrective action.
authors.affiliation: Department of Education, Quality and Research, Alabama Quality Assurance Foundation, Inc.
authors.forename: R G
authors.initials: RG
authors.lastname: Sherrill
authors.forename: H M
authors.initials: HM
authors.lastname: Hood
authors.forename: W D
authors.initials: WD
authors.lastname: Everett
authors.forename: N
authors.initials: N
authors.lastname: Schiesz
authors.forename: J S
authors.initials: JS
authors.lastname: Lowe
authors.forename: J F
authors.initials: JF
authors.lastname: DeLong
mesh_terms: D000407:Alabama; D003695:Delivery of Health Care / Q000592:standards*; D015285:Hospital-Patient Relations; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards; D007902:Length of Stay; D016344:Medicare Part A; D010351:Patient Discharge / Q000592:standards*; D011366:Professional Review Organizations / Q000592:standards*; D011787:Quality of Health Care; D014481:United States