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Article
August 8, 1977

Medical Audit JCAH-Style: A Negative View

JAMA. 1977;238(6):479. doi:10.1001/jama.1977.03280060023005

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Abstract

To the Editor.—  Dr Rosenberg's commentary is well delivered and well deserved. I offer the following continuing criticisms.

  1. The reason for the success of the Performance Evaluation Procedure (PEP) format is the Professional Service Review Organizations (PSRO) legislation requiring audit and threatened loss of accreditation if audit was not being performed.

  2. There is no provision for diagnostic nonsequitur (was the outcome really the outcome of the disease treated?).

  3. The exception to criticism no. 2 is by tissue removal. The major area of effectiveness of PEP is in surgical areas of pathologically significant tissue removal.

  4. It assumes that illness care ceases at the hospital door, asking only that follow-up be commented on.

  5. It cannot lead to substantial changes in medical care because of No. 4 and the lack of continuity through an illness implied therein.

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