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Evaluation & the Health Professions
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Quality Improvement in Health Care

A Brief History of the Medicare Peer Review Organization (PRO) Initiative

Cynthia Weinmann

Delmarva Foundation for Medical Care

The Medicare Peer Review Organization (PRO) program began in the mid 1980s in response to concerns with medical necessity and qualityof care of services delivered to the elderly and disabled, and paidfor by the federal Medicare program. As part of their legislated oversight, PROs reviewed a random sample of hospital medical records. Using locally developed and maintained clinical criteria, PRO nurse and physician reviewers made determinations about the medical necessity of the inpatient stay and services, and identified issues with the quality of care delivered. Within 10 years of its initiation, however, criticisms of the PRO program, based in the reliability and validity of review findings, combined with national interest in quality improvement, led HCFA to refocus the program. PROs currently emphasize clinical and process quality improvement, through collaborative working relationships with providers and consumers.

Evaluation & the Health Professions, Vol. 21, No. 4, 413-418 (1998)
DOI: 10.1177/016327879802100401
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This article has been cited by other articles:


Home page
 Eval Health ProfHome page
M. E. Fitzgerald, G. F. Molinari, and R. B. Bausell
The Empowering Potential of Quality Improvement Data
Eval Health Prof, December 1, 1998; 21(4): 419 - 428.
[Abstract] [PDF]