During the 1970s, effоrts were mаde tо stаndаrdize further and imprоve the clinical services provided by physicians and hospitals. Under the authority of Medicare officials, hospitals were mandated to conduct health record audits to identify physicians with substandard practice patterns or excessive patient care costs. Local peer review organizations (PROs), usually sponsored by local medical societies, reviewed the findings at each local institution and developed recommendations for physician continuing education. These audit activities were designed to: