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Evaluating the impact of physician peer review: factors associated with successful PSROs.

N E Adler and A Milstein

A five-component measurement method was developed and applied to the 1981 impact statements of 30 Professional Standards Review Organizations (PSROs) by four blind raters familiar with the PSRO program. High inter-rater reliability (.95) was achieved. Rater's scores for each PSRO were then averaged and regressed against five variables predicted to affect PSRO impact: geographical density of PSROs; PSRO affiliation with a medical society; surgical necessity review; use of data profiles; and pre-existing Medicare hospitalization rates. As a set, the variables accounted for 44 per cent of the variance in PSRO performance (p less than .05). When entered in stepwise regression, geographical density and use of surgical necessity review accounted for the largest share of the variance. The findings are believed to reflect the recency of PSRO motivation to demonstrate significant impact, and the value of surgical necessity review as an indicator of PSRO courage to risk unpleasant backlash from their medical communities.