Advancing the QI Model for Clinical Peer Review

6/30/2010 – Marc T. Edwards, MD MBA, President & CEO of QA to QI Consulting announced the acceptance of the firm's application for listing as a Patient Safety Organization by the Agency for Healthcare Research and Quality (AHRQ), on behalf of the Secretary of the U.S. Department of Health and Human Services. "The creation of a PSO was a natural extension of our studies of peer review practice and consulting activity. It was about doing the right thing, not about making money."

Over the past 5 years, QA to QI Consulting has developed a suite of evidenced-based products and services in support of healthcare provider efforts to improve quality, safety and resource use. In effect, QA to QI Consulting has been conducting the essential functions of a PSO absent the designation. But this is not a conventional PSO focused on the learning from aggregating many reports of adverse events. "We will fill a specialized niche to promote quality and safety through better clinical peer review process. In this role, our contracts are as likely to be with other PSOs as with individual providers. The PSO will enhance our service to clients and strengthen our program of operations research."

Dr. Edwards has conducted 2 national studies of hospital peer review practices and published 5 related journal articles. These investigations show that relatively small changes in the peer-review process can contribute to significant improvements in quality and safety in a large proportion of U.S. hospitals. They also defined an evidence-based, best-practice model for peer review: the QI Model.

The impetus to form a PSO came from members of the ACPE (Tampa, FL;  now the American Association for Physician Leaders, the premier membership association for physician leaders). The ACPE was a sponsor of both national studies and had been approached about the non-commercial Normative Peer Review Database Project which extends this work to create the reference point from which to validate best practices and otherwise evaluate peer review program improvement efforts. Dr. Edwards said, "Physician leaders expressed that, in some states, the statutory protections for peer review could be compromised by the simple act of reporting even high-level program data to an outside entity. When I asked whether reporting to a PSO could neutralize this problem, one hospital's attorney gave a favorable response. Further due diligence confirmed that the concept was viable and my firm eligible."

PSOs are designed to help clinicians, hospitals and healthcare organizations improve the care they deliver to patients by encouraging them to conduct quality and safety analyses. Through federal protections of legal privilege and confidentiality, which are authorized by the Patient Safety and Quality Improvement Act of 2005, PSOs foster a culture of safety and create a secure environment where providers can collect and analyze data to identify and reduce the risks and hazards associated with patient care. "We know that clinicians and healthcare organizations want to participate in efforts to improve patient care, but they often are inhibited by fears of liability and sanctions," said AHRQ Director Carolyn M. Clancy, MD. "PSOs facilitate a shared-learning approach that supports effective interventions to reduce risk of harm to patients and improve quality."

The QA to QI Consulting PSO will not only offer the protections needed to promote wide participation in the Normative Peer Review Database Project, it will also provide a platform for dissemination of knowledge and tools for improving quality and safety through better peer review process. Discussions have already been initiated to provide such services on behalf of other PSOs. Dr. Edwards hopes to be able to announce several formal relationships in the near future.

In the process of preparing for the launch of the PSO, QA to QI Consulting invested in enhancements of its flagship product, PREP-MSTM peer review program management software. As Dr. Edwards explained, " We updated the database taxonomies for compatibility with AHRQ's Common Formats. In fact, PREP-MSTM goes well beyond the Common Formats in contributing to standardization. We also added fields to support proper documentation of Patient Safety Work Product for organizations wanting to assure a greater degree of peer review protection by reporting cases to a Patient Safety Organization. Equally importantly, we augmented the reporting capabilities, data quality controls and software interoperability. I wanted to assure that PREP-MSTM continues to set the standard for best practice in clinical peer review program management support. There is no better product for clinical performance measurement and feedback. PREP-MSTM makes it easy to implement the QI Model for peer review." (see the press release from 6/16/10)

QA to QI LLC dba QA to QI Consulting (West Hartford, CT; is a boutique firm specializing in the development of new tools for healthcare improvement through operations research.