Abstract
A major criticism of traditional institutional utilization review activities has been the lack of objectivity in assessing the necessity and appropriateness of care. The review systems for Professional Standards Review Organizations (PSROs) and for utilization review require the use of objective measures in assessing care provided to Medicare, Medicaid, and Title V patients admitted to short stay general hospitals. The PSRO Manual defines these measures as follows: Norms—Numerical or statistical measures of usual observed performance, e.g., the average length of stay for a particular diagnostic category in a hospital is 4.6 days. Criteria—Predetermined elements against which aspects of the quality of a health service may be compared.
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