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October 3, 1977

Medical Audit

JAMA. 1977;238(14):1501. doi:10.1001/jama.1977.03280150071019

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To the Editor.—  Rosenberg's negative COMMENTARY on "Medical Audit JCAH Style" applies perhaps with even more force to review of cases with chronic pain by the Professional Service Review Organization (PSRO). In March 1976 in Seattle the Washington State Medical Association co-sponsored a symposium on "Surgery for Chronic Low Back Pain: Is It Obsolete?" John Stewart, MD, a very respected Seattle orthopedist, presented an impressive and equally negative analysis of "Quality Control at the Hospital Level" in such cases, by PSRO or otherwise.It is increasingly evident that in contrast to acute disease, the outcomes of many forms of treatment of chronic disease often are not clear for three years or more. The number of cases of unsuccessful low back surgery for chronic back pain, owing their poor results to in-hospital problems tracked by length of stay or any other discharge criteria, appears to be insignificant. Development of new long-term