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Peer review: a new tool for quality improvement.

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Consider the basic prescription for adopting the quality improvement model of peer review and use a self-evaluation to rate your current peer review program.

What is the value of peer review in your organization? Is it likely that the program makes a significant ongoing impact on the quality, safety and patient-oriented outcomes of care? Or do you take it for granted that, in an era when health care organizations have embraced quality improvement principles, peer review has become an anachronism?

Based on my research and industry experience, I've found that many physician executives would like to obtain greater value and would say the program could be vastly improved.

For this reason alone, it may be premature to declare the death of peer review. In fact, I have come to view peer review as a new frontier for quality improvement: both in terms of a field that is ripe for the systematic application of quality improvement principles; and as a refurbished tool to assist in the unending quest for better patient care.

Finding a dearth of literature on how to improve peer review, I undertook to assess the current state of the field together with Evan Benjamin, MD, chief quality officer at Baystate Health in Springfield, Mass.

With support from the ACPE, the University HealthSystems Consortium, Premier, Inc., and seven state hospital associations, we did an online survey of physician executives and hospital leaders. The survey covered 39 items related to peer review program structure, process, governance and outcomes, guided by the framework shown in Figure 1 (view the complete survey at www.wilson-edwards.com/survey./htm).

[FIGURE 1 OMITTED]

We ultimately acquired data from 339 institutions spanning the full spectrum of size and location, including 61 major teaching hospitals. The study offers a roadmap to territory where none previously existed.

We observed wide variation in practices. There were also some constants. Peer review is synonymous with, but not limited to, retrospective medical record review. Among other methods, cases are identified through generic screens for adverse events. Peer review is conducted in committees.

Important decisions are generally made by consensus, although in major teaching hospitals decision making by the department chair runs a close second. The overall staffing commitment to support peer review activity is relatively small: a median of 1.1 FTE per 100 beds, a mere 0.2 percent of the average hospital staffing. Most peer reviewers (80 percent) are not compensated.

But our key finding was the predictive value of specific practices on...

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