Peer Review Monthly: Defining peer review

Editor's note: This is the first article in a new monthly series written by Robert Marder, MD, vice president of The Greeley Company. The series will address the topic of peer review.

In the coming months, I hope to address challenges you face in performing peer review, a critical yet difficult medical staff function. The series will also include case studies to test your peer review IQ.

I thought I would start this series by discussing the contemporary definition of peer review. Peer review is best defined as:
 
The ongoing evaluation of an individual physician's professional performance, for all areas of physician competency, using multiple sources of performance data.

This definition allows the medical staff peer review process to move away from relying on individual chart-based, technically focused reviews in two ways. First, it helps the medical staff broaden its assessment of physician competency by looking all six general competencies as defined by the Accreditation Council for Graduate Medical Education (ACGME) and The Joint Commission. Second, it allows the medical staff office to aggregate data, such as rate and rule measures, to evaluate physician performance and meet The Joint Commission's standards for ongoing professional practice evaluation (OPPE).
 
When defining a peer, medical staffs should take the expertise of the reviewer and the relationship of the reviewer to the medical staff into consideration. While a "peer" has traditionally been viewed as a physician in the same specialty as the physician being reviewed, the contemporary definition according to The Greeley Peer Review Policy is:

An individual practicing in the same profession and who has expertise in the appropriate subject matter. The level of subject matter expertise required to provide meaningful evaluation of a practitioner's performance will determine what "practicing in the same profession" means on a case-by-case basis. For example, for quality issues related to general medical care, a practitioner (MD or DO) may review the care of another practitioner. For specialty-specific clinical issues, a peer is an individual who is well-trained and competent in that specialty. 

This definition recognizes the cross-specialty nature of medical staff privileges. For example, issues related to conscious sedation or anti-coagulation can be addressed by many specialties. The definition also recognizes that many issues related to physician competency are global, such as communication and patient safety. The medical staff as a whole needs to set physician performance standards in these areas.

In addition, this definition allows for the use of multi-specialty peer review committees. This type of structure improves efficiency by decreasing the number of committees required by the medical staff and reduces specialty bias. 

The Greeley Company has begun to use two terms that describe the relationship of the reviewer to the medical staff: internal peer review (IPR) and external peer review (EPR). While these terms are often seen as separate silos of the peer review function, they should be viewed as tools that use different resources to acquire fair, efficient, and useful information to evaluate and improve physician performance. Organizations need solid IPR systems and clear policies for using EPR evaluations.

Robert Marder, MD
vice president
The Greeley Company