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Ideas and Opinions |15 December 1993

The Uniform Clinical Data Set: An Evaluation of the Proposed National Database for Medicare's Quality Review Program

Anne-Marie Audet, MD, MSc, SM; H. Denman Scott, MD, MPH

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Copyright 2004 by the American College of Physicians
2004
  • From the American College of Physicians, Philadelphia, Pennsylvania. Requests for Reprints: Anne-Marie Audet, MD, MSc, SM, American College of Physicians, Independence Mall West, Sixth Street at Race, Philadelphia, PA 19106-1572.
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Medicare's program for quality review and assurance is in the midst of reform. The current Peer Review Organization (PRO) program was created for this purpose in the early 1980s. Unfortunately, a decade of experience has revealed failures in many respects. The PRO review process varies greatly from state to state [1, 2]. The accuracy and reliability of the data used to assess the quality of care are questionable [3]. The development of criteria used to evaluate quality has not been systematic or scientific. In many cases these criteria have been kept secret and have either never been validated or have proved to be poor predictors of quality-of-care problems [3-6]. The case-by-case approach to reviews has been criticized for being intrusive and disruptive of the delivery of health care. Its punitive tone has also been counterproductive, impeding efforts to improve quality instead of promoting them [7, 8]. Finally, evidence concerning the effect of PROs' reviews on the cost-effectiveness and the quality of care of Medicare beneficiaries remains lacking. Due to these facts, the credibility of the Medicare quality assurance program is at stake.
Recognizing the need for reform, the Health Care Financing Administration (HCFA) has proposed a new direction for the PROs' reviews of quality: the Health Care Quality Improvement Initiative. The primary goal is to replace the punitive model of peer review with one that emphasizes education and continuous quality improvement [7, 8]. A major change is that the predominant form of review in the...
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Audet A, Scott HD. The Uniform Clinical Data Set: An Evaluation of the Proposed National Database for Medicare's Quality Review Program. Ann Intern Med. 1993;119:1209–1213. doi: https://doi.org/10.7326/0003-4819-119-12-199312150-00008

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Published: Ann Intern Med. 1993;119(12):1209-1213.

DOI: 10.7326/0003-4819-119-12-199312150-00008

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