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Health services administration -- Data processing. --- Information storage and retrieval systems -- Medical care.

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Health status indicators. --- Health status indicators --- Health surveys --- Psychometrics. --- Questionnaires.

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The analysis in this report explores the potential role of Professional Standards Review Organizations (PSROs) in medical technology assessment. PSROs represent the only physician peer review institution with several characteristics presumably important both to efficient and widespread dissemination of information pertaining to medical technology assessment and to the promotion of timely changes in medical practice among physicians. Particular attention is given to (1) the "upward" transfer of data and information pertinent to technology assessment and (2) the "downward" dissemination of information to practicing physicians as part of PSROs' sustained efforts to promote change and improvement in medical practice. Several recommendations are presented regarding PSRO involvement in the technology assessment field, including specific proposals as to how some of these recommendations might be initiated and tested.

Professional standards review organizations (Medicine) --- Medical technology --- Communication in medicine. --- Diffusion of innovations. --- Peer review --- Information services. --- Peer review. --- Technology assessment, Biomedical --- Evaluation. --- Methods.

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This Note analyzes the literature regarding appropriateness of acute care provided to the elderly. The authors identified 17 articles that explicitly cited appropriate or inappropriate care (including undercare, overcare, and misuse) provided in hospital and ambulatory settings and for procedures, and 19 articles that presented data on the appropriateness of medication use in the elderly. Virtually every study found at least double-digit levels of inappropriate care. Perhaps as much as one-fifth to one-quarter of acute hospital services or procedures were felt to be used for equivocal or inappropriate reasons, and two-fifths to one-half of the medications studied were overused in outpatients. The few studies that examined underuse or misuse of services also documented the existence of these phenomena. This was especially true for the ambulatory care of chronic physical and mental conditions and concerned the use of low-cost technologies (visits, preventive services, some medications). Thus, the authors conclude that there appears to be a substantial problem in matching acute services to the needs of elderly patients. This mismatch occurs both in terms of overuse and underuse, at least for areas where research has been conducted.

Older people --- Older people --- Medical care --- Evaluation. --- Medical care --- Government policy