Reduce outcome bias through focused reviewer questions

The goal of physician review is to evaluate the appropriateness of care, independent of patient outcome. Although reviewers often believe that outcome is of primary importance, it is well known that a patient can have an adverse outcome that is not due to physician care or have an acceptable outcome despite a significant lapse in care (e.g., a so-called “near miss”).

A useful strategy to reduce outcome bias is to have the screener provide case-specific questions for the reviewer that are focused on the process of care rather than the outcome. While generic questions can be helpful (e.g., was an important diagnosis not considered? Was an important procedure, medical treatment, consultation, or diagnostic test not performed?), many medical staffs have found that questions about specific care processes are more useful (e.g., should the internist have adjusted the patient’s potassium level immediately rather than four hours later? Should the surgeon have arranged the performance of a CT before taking the patient to the OR?) Specific questions have three benefits:

  • They focus reviewers more on the process of care and less on the outcome
  • They ensure that reviewers will address the reasons the case was selected for physician review
  • They save physicians time in reviewing the medical record

Source: News & Analysis