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February 16, 1976

Pay the Peers: Utilization Review With a Team Approach and Payment of Physician Reviewers

Author Affiliations

From The Queen's Medical Center, Honolulu.

JAMA. 1976;235(7):738-741. doi:10.1001/jama.1976.03260330032019

IN HAWAII, physicians began efforts to improve quality care for hospitalized patients in 1965. Since then, several statewide studies have revealed that nonpunitive peer review systems are ineffective.1,2 Realizing this, The Queen's Medical Center in Honolulu (480 beds) revised its utilization review program in September 19733 to comply with Public Law 92-603 (professional standards review organizations) and with Titles V, XVIII, and XIX under the Social Security Act.

The distinguishing characteristics of our utilization review program are twofold: (1) a team approach, utilizing paramedical staff as well as physicians, and (2) payment for peer review. In an effort to contain costs, our objective is to reduce a patient's length of stay, particularly in the expensive care units. Therefore, high priority is given to analyzing appropriateness of admission, length of stay based on level of care, early diagnosis, proper management, and prompt discharge. Our evaluations focus on facts rather