Peer review in unusual places

Last week, I had the opportunity to present a program on effective peer review to a clinical group I had not worked with previously. The group was comprised of physicians, optometrists, and nurse practitioners from a university student health service. They had requested the program because the university had done an internal review and determined that they were not compliant with AAAHC accreditation standards.

There were a number of differences between how peer review was addressed by this group and the typical hospital medical staff. Here are some of them:

• They are all employed staff so they did not have a sense of medical staff self governance
• AAAHC requirements for peer review are relatively loose compared to hospital accreditation
• There is little infrastructure in place to support the peer process or collect data
•  The types of cases coming to review represent a lower level of adverse outcome
• There are only a minimal number of nationally defined measures for them to benchmark their performance

Despite these differences, there were at least three remarkable similarities to many hospital medical staffs that have come to our national seminars on peer review.  Many of the clinicians felt that their review process in the past seemed punitive and desired to take a more positive, performance improvement approach. Although the process could be done more efficiently via an employee supervisory model, the clinicians felt it was important that they become more involved in peer review to ensure the process was fair. Finally, although the initial impetus for the program was due to regulatory concerns, they sought to design their program using best practices to achieve a performance improvement approach to peer review so they could help each other provide better patient care.

I left realizing that the fundamental concepts of peer review are applicable in a wide array of practice settings.  I believe our health system is moving toward greater regulatory oversight of patient care in settings that were traditionally not responsible for evaluating their care.  Hospitals have the choice to do the minimum to pass regulatory standards or embrace self-evaluation to provide the best care possible. Ambulatory care organizations now face the same choice. My hope is that, like the group I just visited, they will choose wisely.

Robert J. Marder, MD, CMSL, is vice president of The Greeley Company, a division of HCPro, Inc. in Danvers, MA.