MEDICINE AND PUBLIC ISSUES Effect of Medical Care Review on the Use of Injections A Study of the New Mexico Experimental Medical Care Review Organization

Evaluation of peer review activities in the New Mexico Medicaid program (1971 to 1973) showed that it can affect aspects of quality, that is, the appropriateness of the use of injections as judged by medical criteria. Use of injections, nearly 5 0 % of which were antibiotics, declined by more than 6 0 % , from 41 to 16 per 100 ambulatory visits. Still, at the end of the study, 4 0 % of the injections given were considered medically unnecessary. Analyses showed that [1] groups used injections more appropriately; [2] for solo physicians, being board-certified, being a doctor of medicine, and being a pediatrician were all associated with more proper use of injections; [3] 6 % of the physicians gave 4 0 % of the medically unnecessary injections, but even their behavior changed dramatically for the better as a result of the peer review system. EFFORTS TO IMPROVE THE QUALITY of medical care are here to stay. No longer confined to the theorist, they are mandated by two federal laws (1, 2) and one national pro-fessional organization, the Joint Commission on Accredita-tion of Hospitals (3). Little is known about the effective-ness of these quality assurance activities. The amount of rhetoric addressed to this question is enormous (4-8); the amount of data is negligible. Most studies of Pro-fessional Standards Review Organizations (PSROs) or their prototypes have been concerned with their effect on cost variables (for example, cost of hospital care), not on quality variables (9-11). One study examined the effect of the San Joaquin Foundation for Medical Care on the use of ambulatory services; it showed small but significant improvements (12). Although the PSRO program is being vigorously implemented, information about the potential impact that PSRO will have on quality is virtually non-existent. The purpose of this paper is twofold: [1] to describ