Does Clinical Peer Review Really Improve the Quality and Safety of Medical Care?

5/10/2010 – Marc T. Edwards, MD MBA, President & CEO of QA to QI Consulting announced that 2 manuscripts reporting the results of the ACPE Clinical Peer Review Outcomes Study have been accepted for publication by the American Journal for Medical Quality (AJMQ): Clinical Peer Review Program Self-Evaluation for US Hospitals and The Objective Impact of Clinical Peer Review on Hospital Quality and Safety. Despite the overall importance of the peer review process to the profession of medicine and to the quality and safety of patient care, this was the first study of its kind.

Overall, the study confirmed the primary findings from 2007, validated the utility of the Peer Review Program Self-Evaluation Tool, identified the influence of organizational culture on program effectiveness, and linked specific program characteristics embodied by the QI Model to better performance on objective measures of hospital quality and safety. More than half of US hospitals rely on an outmoded and dysfunctional methodology for peer review. The published articles will offer considerable practical advice for program improvement.

Objective data for quality and patient safety came from the CMS Hospital Compare website, and with cooperation from leadership at Thomson Reuters, Premier CareScience and HealthGrades. Data collection for the study ran from August 11 through September 30, 2009. Online publication of the articles is expected this summer. Says Dr. Edwards, "I am most pleased with the rapid cycle from data collection to reporting of results for this study. The frustration of getting the first National Peer Review Practices Survey results in to print was a good learning experience. I am already working on the next phase of research into best practices. The Normative Database Project will serve as the primary platform for data collection."

This brings Dr. Edwards' total of scientific manuscripts related to clinical peer review accepted to peer-reviewed journals to 5, ranking him with the foremost researchers on the subject.

The ACPE (Tampa, FL;  www.ACPE.org) is the premier membership association for physician leaders.  It is dedicated to education and professional development.  QA to QI LLC dba QA to QI Consulting (West Hartford, CT; www.QAtoQI.com) is a boutique firm specializing in the development of new tools for healthcare improvement.

Abstract: Clinical Peer Review Program Self-Evaluation for US Hospitals
Prior research has shown wide variation in clinical peer review program structure, process, governance and perceived effectiveness. This study sought to validate the utility of a Peer Review Program Self-Evaluation Tool as a potential guide to physician and hospital leaders seeking greater program value. Data from 330 hospitals show that the Total Score from the Self-Evaluation Tool is strongly associated with perceived quality impact. Organizational culture also plays a significant role. When controlling for these factors, there was no evidence of benefit from a multi-specialty review process. Physicians do not generally use reliable methods to measure clinical performance. A high rate of change since 2007 has not produced much improvement. The Peer Review Program Self-Evaluation Tool reliably differentiates hospitals along a continuum of perceived program performance. The full potential of peer review as a process for improving the quality and safety of care has yet to be realized.
Abstract: The Objective Impact of Clinical Peer Review on Quality of Care
Despite its importance, the objective impact of clinical peer review on the quality and safety of care has not been studied. Data from 296 acute care hospitals show that peer review program and related organizational factors can explain up to 18% of the variation in standardized measures of quality and patient safety. The majority of programs rely on an outmoded and dysfunctional process model. Adoption of best practices informed by continuing study of peer review program effectiveness has potential to significantly improve patient outcomes.