Quality of care problems among Medicare patients in New York State.

The Island Peer Review Organization is the peer review organization in New York State and is under contract with the Health Care Financing Administration to monitor the quality of care rendered to Medicare patients. A severity level III is assigned when a confirmed quality problem with significant adverse effects for the patient is confirmed. A severity level II is assigned when a confirmed quality problem with the potential for significant adverse effects on the patient is found. The purpose of this study was to retrospectively analyze all 85 severity level III citations and a 12% (223) random sample of the 1,880 severity level II citations for 1991. Another objective was to characterize the providers involved in each of these two levels of quality of care problems. Among the 85 severity level III citations, 34 (40.0%) involved premature death and 33 (38.8%) readmission. Treatment (45.0%), diagnostic (16.9%), and monitoring (16.4%) problems accounted for 78.3% of the 189 problems identified in severity level III citations. The leading problem areas were the treatment of infections and the use of antibiotics (21.2%), fluid and electrolyte management (21.2%), drug use (9.4%), the use of endotracheal tubes (5.9%), the management of diabetes mellitus (5.9%), and the management of hematologic disorders (5.9%). Attending physicians (65.9%), nursing departments (16.5%), and resident physicians (7.1%) were involved in the vast majority (89.5%) of severity level III citations. Treatment problems comprised 60.5% of the 243 problems found in severity level II citations, followed by inadequate work-up (20.2%), and incomplete documentation (12.3%).(ABSTRACT TRUNCATED AT 250 WORDS)