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PubMed1996

Group peer review in psychiatry: the relationship to quality improvement and quality care.

OBJECTIVE: This study sought to elucidate the contribution of peer review groups involving psychiatrists to quality improvement and quality care. METHOD: Audio-taped interviews of groups engaged in peer review were analysed using a qualitative methodology. Participants' views of the ways in which they experienced and conceptualised peer review were explored. RESULTS: The views of participants in peer review groups were analysed, and categories evolved which identified differences in how they perceived the structure and function of group peer review. CONCLUSIONS: Participants in the groups studied perceived peer review as a professional growth forum within a quality improvement framework providing critical review of treatment, continuing education, and a sense of collegiality. Boundaries of acceptable practice were tested and defined. At its best, participation in peer review groups enhanced reflective practice which achieved new understandings of clinical work. In this regard, peer review is seen as a highly desirable method for the maintenance of professional standards.

Attitude of Health Personnel↗
PubMed1989

Assessing peer review in the quest for improved medical services.

The increased concern about the quality of medical services evidenced by, inter alia, the growing attention to quality of Peer Review Organizations. The purchasing and implementation of sophisticated medical data systems by hospitals, and the growing clamor from private health insurers and employers about the rapidly rising costs of health services has made determining the effectiveness of medical interventions a priority subject for many authorities in the field of medical care assessment. At the risk of oversimplification, the view that a greater focus on quality of health services is overdue has begun to energize healthcare institutions, the health professions, payers, and the general public. The objective of this paper and those that will follow is to examine medical peer review. Medical peer review involves peer appraisal in at least two stages: in criteria and standard setting (1, 2), and in determining whether criteria and standards have been met by practitioners in the rendering of services (2). This first article describes some difficulties with the information available to facilitate effective medical peer review, and examines the processes that provide the knowledge base upon which medical peer review depends.

Peer Review↗
PubMed1977

Peer review: accountability and legal implications.

In summary, increasingly accountability implies the acceptance of peer review as an integral part of nursing practice. Peer review in turn presents a variety of ethical and legal implications and, beyond the scope of this discussion, educational, organizational and psychological implications as well. We must proceed to identify the components necessary to a sound peer review approach, starting with ethical issue and the necessary data base to measure outcomes of care right through the mechanisms of process and structural arrangements. Then, of course, we must ensure the application of rigorous examination of results. Whether QAPs as a whole or peer review as a specific, results are not dependent solely on the provider and client. Environmental and organizational factors must also be considered. Outcomes of care and performance are a function of the interaction of a variety of factors. In essence, the onus for assuring that the profession will meet its public accountability rests largely with each and every one of us. Every professional practitioner in the context of peer review will be compelled to be involved in assessment of the many dimensions of patient care. If professional self-requlation is to be effective, all professional nurses must be involved. In sum, we are the ones who must determine the what and the how of accountability for the nursing profession.

Ethics, Nursing↗
PubMed2006

[Assurance of process-quality in pulmonary practice by means of a peer-review system--a pilot project].

Quality assurance and quality-management have been well anchored in social legislation for years. Peer-reviews to assure process-quality and quality of outcomes have been conducted repeatedly in centres for pulmonary medicine, facilities for pulmonary rehabilitation as well as centres for sleep-medicine. By means of a pilot study we wanted to investigate if assurance of process-quality is feasible and if a peer review system turns out to be a suitable method in pulmonary practice. Medical reports and/or diagnostic protocols of the investigational procedures such as pulmonary function tests, allergy-tests, induction test of bronchial hyperresponsiveness et cetera were randomly collected from nine patients with bronchial asthma or COPD in each of the 44 participating pulmonary practices and forwarded to three peer-reviewers respectively. 396 selected patient-datasets resulted in 1188 reviews. Peer review was conducted by means of a specially developed checklist of markers of process-quality accompanied by an explanatory manual. Measures of quality were determined for every pulmonary practice and a report of results was generated. The health economical efficacy of the therapy and the diagnostic process as well as an assessment of the overall process was evaluated by means of a visual analogue scale. No deficiencies could be detected in clearly more than half of the assessments. Major deficiencies or an unacceptable result in different items could be detected in every sixth assessment. For every item a graphic ranking in terms of benchmarking was generated for each individual report. Since peers were reviewers and subjects of review at the same time, they can now clearly improve and assure their diagnostic and therapeutic process-quality in patients with bronchial asthma and COPD by means of the experience they gained during the review process, as well as by the assessment they received. We were able to demonstrate that a peer-review-system is appropriate to assure process-quality in pulmonary practice and that it is feasible to achieve a continuous assurance and improvement of quality in the long run.

Asthma↗
PubMed1976

Psychiatric peer review: a working model.

The author describes a system for psychiatric peer review developed by a peer review committee in a general hospital. At the heart of the system is a form called the peer review check sheet, which requires the physician to specify diagnosis, reasons for hospitalization, and major symptom complexes, as well as laboratory work and treatment and discharge plans. Minimal criteria have been established to verify the diagnoses and to justify the need for hospitalization. Each month the check sheets are removed from the charts of patients who have been discharged and sent to committee members for evaluation. Those that are incomplete or unsatisfactory signal the need to examine the patient's chart.

Feedback↗
PubMedDate not supplied

Peer review for advanced practice nurses: what does it really mean?

Peer review has multiple manifestations and purposes. Two stated purposes are the demonstration of professionalism and clinical competency. The American Nurses Association (ANA) defines nursing peer-review as a process for evaluating the care provided by an individual according to accepted standards. Further, the ANA proposes that nurses with similar rank and clinical expertise should conduct these evaluations. Some local jurisdictions may also mandate that advanced practice nurses (APNs) review one another's care. Therefore, APNs should become familiar with sources for evaluation criteria and tool formats for APN peer review. The advantages and limitations of the various formats and processes of peer review should also be considered.

American Nurses' Association↗
PubMed1996

Developing a cooperative provider-based statewide peer review service: early experience.

The purpose of this study was to demonstrate the feasibility of a model of overcoming local barriers to physician peer review through development of a statewide provider-based physician peer review service. For this purpose, the cooperative demonstration project of the Institute for Quality Healthcare, The University of Iowa and The Robert Wood Johnson Foundation, was used. A consortium of 43 Iowa hospitals developed a physician peer review service utilizing a pool of physician reviewers from member hospitals. Thirty-six peer reviews were conducted in 23 different hospitals by 37 different reviewers throughout the state of Iowa in the first 2 years of operation. Reviews of surgical specialists, psychiatrists, and psychiatric services were requested most frequently. The satisfaction of hospitals with the physician peer review service has thus far been gratifying. The long-term financial viability of the physician peer review service has yet to be demonstrated. This cooperative organizational model of a provider-based physician peer review service may be reproducible and valuable to health care providers in other parts of the United States.

Academies and Institutes↗
PubMed1996

Using clinical audit in practice: a pilot peer review project.

A well-established study group undertook a pilot peer review project testing the use of clinical audit in members' practices. Two peer review groups were formed involving a total of 16 practices. Practice visits were undertaken and a series of meetings were held to prepare and discuss the various projects. The progress of the groups was monitored by questionnaires. All practitioners reported benefits from the project (specifically, from the practice visits) and made changes in areas of their practice other than those specifically chosen for their project. The benefits of carrying out audit projects in a peer review setting are stressed as are the benefits of reciprocal practice visits. The importance of prior establishment of mutual trust and confidence in the peer review group is emphasised.

Dental Audit↗
PubMed2004

Peer review audit of trauma deaths in a developing country.

OBJECTIVES: Peer review of trauma deaths can be used to evaluate the efficacy of trauma systems. The objective of this study was to estimate teh proportion of preventable trauma deaths and the factors contributing to poor outcome using peer review in a tertiary care hospital in a developing country. METHODS: All trauma deaths during a 2-year period (1 January 1998 to 30 December 1998) were identified and registered in a computerized trauma registry, and the probability of survival was calculated for all patients. Summary data, including registry information and details of prehospital, emergency room, and definitive care, were provided to all members of the peer review committee 1 week before the committee meeting. The committee then reviewed all cases and classified each death as preventable, potentially preventable, or non-preventable. RESULTS AND CONCLUSION: A total fo 279 patients were registered in the trauma registry during the study period, including 18 trauma deaths. Peer review judged that six were preventable, seven were potentially preventable, and four were non-preventable. One patient was excluded because the record was not available for review. The proportion of preventable and potentially preventable deaths was significantly higher in our study than from developed countries. Of the multiple contributing factors identified, the most important were inadequate prehospital transfer, limited hospital resources, and an absence of integrated and organized trauma care. This study summarizes the challenges faced in trauma care in a developing country.

Adolescent↗
PubMed2003

Impartial judgment by the "gatekeepers" of science: fallibility and accountability in the peer review process.

High publication demands and the low acceptance rate of peer review journals place the journal editors and their reviewers in a powerful position. Journal reviewers have a vital role not only in influencing the journal editor's publication decisions, but also in the very nature and direction of scientific research. Because of their influence in peer review outcomes, journal reviewers are aptly described as the "gatekeepers of science." In this article we describe several pitfalls that can impede reviewers' impartial judgement. These include such issues as confirmatory bias, the negative results bias (the file drawer problem), the Matthew effect, the Doctor Fox effect, and gender, race, theoretical orientation, and "political correctness." We argue that procedures currently used by many professional journals, such as blind or masked review, may not completely alleviate the effects of these pitfalls. Instead, we suggest that increasing reviewers' awareness of the pitfalls, accountability, and vigilance can improve fairness in the peer review process. The ultimate responsibilities belong to the journal editors who are confronted with the difficult task of satisfying journal readers, contributors, reviewers, and owners. We recommend that the journal editors conduct periodic internal and external evaluations of their journals' peer review process and outcomes, with participation of reviewers, contributors, readers and owners.

Judgment↗
PubMed1994

Do readers and peer reviewers agree on manuscript quality?

OBJECTIVE: To study readers' judgments of manuscript quality and the degree to which readers agreed with peer reviewers. DESIGN: Cross-sectional study. SETTING: Annals of Internal Medicine. SUBJECTS: One hundred thirteen consecutive manuscripts reporting original research and selected for publication. Each of two manuscript versions (one before and one after revision) was judged by two readers, randomly sampled from those who said (based on the title) that they would read the article; one peer reviewer (peer), chosen in the usual way for Annals; and one expert in clinical research methods (expert). Each judge completed an instrument that included a 10-point subjective summary grade of manuscript quality. MAIN OUTCOME MEASURES: Agreement on the 10-point summary grade of manuscript quality between reader-expert, reader-peer, and reader-reader. RESULTS: Readers and peers gave high grades (77% and 73% gave a grade of 5 or better, respectively), while experts were more critical (52% gave a grade of 5 or better; P < .0001). Agreement was relatively high among judge groups (in all cases, > 69%) but agreement beyond chance was poor (kappa < 0.04). One third of readers (33%) thought that the manuscript had little relevance to their work. CONCLUSION: Readers, like most peer reviewers, are generally satisfied with the quality of manuscripts but would like research articles to be more relevant to their clinical practice.

Cross-Sectional Studies↗
PubMed2006

Conflict of Interest Disclosure Policies and Practices in Peer-reviewed Biomedical Journals.

OBJECTIVE: We undertook this investigation to characterize conflict of interest (COI) policies of biomedical journals with respect to authors, peer-reviewers, and editors, and to ascertain what information about COI disclosures is publicly available. METHODS: We performed a cross-sectional survey of a convenience sample of 135 editors of peer-reviewed biomedical journals that publish original research. We chose an international selection of general and specialty medical journals that publish in English. Selection was based on journal impact factor, and the recommendations of experts in the field. We developed and pilot tested a 3-part web-based survey. The survey included questions about the presence of specific policies for authors, peer-reviewers, and editors, specific restrictions on authors, peer-reviewers, and editors based on COI, and the public availability of these disclosures. Editors were contacted a minimum of 3 times. RESULTS: The response rate for the survey was 91 (67%) of 135, and 85 (93%) of 91 journals reported having an author COI policy. Ten (11%) journals reported that they restrict author submissions based on COI (e.g., drug company authors' papers on their products are not accepted). While 77% report collecting COI information on all author submissions, only 57% publish all author disclosures. A minority of journals report having a specific policy on peer-reviewer 46% (42/91) or editor COI 40% (36/91); among these, 25% and 31% of journals state that they require recusal of peer-reviewers and editors if they report a COI. Only 3% of respondents publish COI disclosures of peer-reviewers, and 12% publish editor COI disclosures, while 11% and 24%, respectively, reported that this information is available upon request. CONCLUSION: Many more journals have a policy regarding COI for authors than they do for peer-reviewers or editors. Even author COI policies are variable, depending on the type of manuscript submitted. The COI information that is collected by journals is often not published; the extent to which such "secret disclosure" may impact the integrity of the journal or the published work is not known.

Conflict of Interest↗
PubMed1985

Formats for peer review of dynamic psychotherapy.

The mental health field must deal with peer review as a fact of life. However, many providers do not understand how to describe the nature or process of the psychotherapy they use, and many peer reviewers seem to lack knowledge of what constitutes a given modality of psychotherapy. If clear definitions of the different modes of dynamic psychotherapy are available--and in fact the literature shows substantial agreement on such aspects as patient selection, time frames, goals, and techniques--formats for the peer review of each modality will naturally follow. The author presents definitions and peer review formats for symptom-relief, supportive, focal, and long-term exploratory psychotherapy.

Humans↗
PubMed2005

Who benefits from peer review? An analysis of the outcome of 100 requests for review by Plastic and Reconstructive Surgery.

BACKGROUND: Little is known of what is done with the comments on submitted manuscripts provided by peer reviewers or to what extent these comments benefit the editor in deciding to accept or reject the manuscript, the author(s) in revising their manuscript, or the readership at large. Furthermore, nothing is known of any possible benefits of the process to the peer reviewer. Finally, the peer-review process may even be maleficent because of its implicit delay of publication and a possible bias against manuscripts originating from non-Anglo-American countries. METHODS: The authors evaluated the benefits of the peer-review process to authors, editor, readers, and reviewers by a bibliometric analysis of the outcome of 100 requests for review made by the editor of Plastic and Reconstructive Surgery from 1992 through 2003. The publication delay and potential geographical bias were evaluated as potential disadvantages. RESULTS: The authors' reviewer advised acceptance of 56 percent of the manuscripts, and the editor mostly agreed with his advice. This suggests that the editor benefited from the review. The authors addressed 48 to 81 percent of the reviewer's constructive suggestions, and this suggests that they and the readers benefited also. Readers of Plastic and Reconstructive Surgery may further benefit because manuscripts rejected by Plastic and Reconstructive Surgery end up in less prestigious journals. The implicit delay of publication is limited, and the authors found no bias against non-Anglo-American submissions. The cost-effectiveness of the process for the peer reviewer remains unclear. CONCLUSIONS: The peer-review system of Plastic and Reconstructive Surgery, in general, is beneficial.

Bibliometrics↗
PubMed1990

Proposed criteria for independent peer reviewers.

Because of the complexity of craniomandibular claims, it is difficult for insurance adjusters to keep up with all of the advances and techniques regarding craniomandibular disorders. Insurance companies have found that they can process claims more quickly and economize by having claims reviewed. Because of this, independent insurance reviews have become routine for TMJ claims. Many practitioners contend that the current review system appears to be lacking in impartiality, criteria for reviewers, and standardized fees for various geographical locations. The author offers suggestions for objective reviews that ensure the use of qualified and responsible reviewers. Setting guidelines for reviewers will bring about more equitable reviews and assist in dismantling the confusion surrounding head and neck claims.

Humans↗
PubMed1979

Peer review for nonphysicians.

The inclusion of nonphysician health care practitioners in hospital quality assurance programs is being called for by the new JCAH standards and PSRO regulations/PSRO guidelines require that nonphysicians be reviewed by peers.

Health Occupations↗
PubMedDate not supplied

Peer review organization payment denials: comparative analysis of emergency department and non-emergency-department admissions.

The Health Care Financing Administration has contracted with regional peer review organizations to review Medicare admissions and to deny payment for hospital admissions that fail to meet peer review organization criteria. The purpose of this study was to compare emergency department admissions with non-emergency-department admissions with respect to rates of peer review organization denial and the reasons for those denials. All hospital Medicare admissions between January 1984 and April 1987 were retrospectively reviewed. Patients were excluded if they received peer review organization pre-authorization prior to admission. The rest were classified by 1) source of admission (emergency department or non-emergency department), 2) peer review organization decision, 3) reason for peer review organization denial, 4) whether the denial was appealed, 5) the results of appeal. Chi-square or Fisher's Exact Test analysis was performed, and P less than 0.05 was considered to be significant. During the 40-month study period, there were 19,847 emergency department Medicare admissions and 19,752 non-emergency-department Medicare admissions. Of the non-emergency-department admissions, 7887 received pre-authorization. None of the emergency department admissions received pre-authorization. Of the 19,847 emergency department admissions, 433 (2.23%) were denied. Of these denials, 269 (60.7%) were appealed by the hospital; 136 (50.5%) successfully. Of the 11,865 non-emergency department, non-pre-authorized admissions, 333 (2.81%) were denied. Of these denials, 174 (52.2%) were appealed, 76 (43.6%) successfully. Overall, emergency department admissions were significantly less likely to receive peer review organization denial than non-emergency-department, non-pre-authorized admissions (P less than 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Preventable trauma deaths: evaluation by peer review and a guide for quality improvement. Emergency Medical Study Group for Quality.

BACKGROUND: The trauma-injury severity-score (TRISS) methodology was developed in the United States to calculate the probability of survival for trauma patients presenting for emergency care. OBJECTIVE: We assessed the utility of using the TRISS methodology to identify preventable trauma deaths and compared the results to peer review using explicit standards. METHODS: Explicit peer review standards were developed by a focus group. The validity of these standards was evaluated by comparing the results of peer review performed by two independent expert panels. All trauma cases admitted to 10 centers in Japan between April 1, 1994, and March 31, 1996, were evaluated using the TRISS methodology. Cases with an expected probability of survival of more than 0.5 were considered preventable. These cases were subjected to peer review. Patients who were dead on arrival were excluded from analysis. RESULTS: Of 3,125 patients who were not dead on arrival, the TRISS methodology identified 2,525 as having a probability of survival greater than 0.5. In this group, 189 patients died; thus, 25.3% of all deaths were considered preventable by the TRISS method. Peer review found that only 11.2% of the deaths were preventable; thus, only 46.6% of preventable deaths identified by TRISS were confirmed by peer review. Agreement between the two expert peer review panels was very good (kappa = 0.62). CONCLUSION: TRISS can be used as a screening tool to identify potentially preventable trauma deaths. Peer review is appropriate to confirm preventability and to identify potential medical errors.

Data Collection↗