Seeking to Better Define Best Practice

9/15/2011 - Marc T. Edwards, MD, MBA, President and CEO of QA to QI Consulting (West Hartford, CT) announced the initiation of the Longitudinal Clinical Peer Review Effectiveness Study. Dr. Edwards notes that "No one has ever reported longitudinal data on peer review program effectiveness. This is very important to do. The high rate of change identified in my prior two national studies and need to refine our understanding of best practice leaves many questions unanswered."

"It occurred to me that the data collected in 2007 and 2009 could be of tremendous value in looking at program changes over time. Although the 2007 study was anonymous by design, about half of participants volunteered contact information. In total, I was able to positively identify more than 450 facilities between the two studies to create the sample frame for this research. The challenge will be to generate a high response rate. On the positive side, these are all individuals who previously responded to a survey on clinical peer review. On the other hand, I'm finding a fairly high rate of staff turn-over, so there will be considerable work ahead to identify replacements."

As an incentive to participate, all data will be Federally protected from disclosure and discovery as Patient Safety Work Product under QA to QI Consulting's Patient Safety Organization. In addition, Dr. Edwards has promised to share preliminary results with participants. He is also offering a 50% discount on PREP-MSTM Peer Review Program Management Software. In order to validate subjective responses, he is seeking to encourage participation in supplemental studies that will look at medical staff opinion survey data and actual program metrics. For this purpose, he is offering pre-prints of all related articles accepted for publication and a free medical staff opinion survey. "Medical staff opinions are important. Many of the available survey vehicles don't focus on the right issues," says Dr. Edwards. "Alignment is a hospital issue, not a physician issue. The relative importance of money and hospital services can be assumed in a business relationship. This leaves the quality and safety of care as the Elephant in the Room which has not been adequately addressed. I've designed a brief survey that specifically targets this area while still capturing opinions on the broad range of hospital services."

Dr. Edwards indicated that the 2009 study revealed the importance of cultural factors in program effectiveness. This survey has been designed to better quantify their impact, particularly in relation to the issue of physician engagement in quality and safety. The draft survey instrument was reviewed for clarity and face validity by a number of physician executives including Julie Felt, Rick Weinberg, Peter Jungblut, and Craig Montgomery. Data collection will likely continue for 3-4 months.

Marc T. Edwards

Marc T. Edwards, MD, MBA is President and CEO of QA to QI Consulting. He operates a Listed Patient Safety Organization, markets clinical peer review program management software, and assists clients to make improvements in quality, safety and resource use. For additional information, visit or contact him directly:; 860.521.8484.

QA to QI LLC dba QA to QI Consulting (West Hartford, CT; specializes in the development of evidence-based tools for healthcare improvement through operations research.