Effect of resident peer review on charting behavior.
Traditionally the medical profession and, more recently, federal agencies have promoted peer review to improve quality of health care, although its effectiveness is uncertain. To assess ability of peer review to increase recording of comprehensive care, the resident charting of growth, immunizations, and family, past medical, developmental, and birth history was monitored in randomly selected charts six months before (747 charts) and six months after institution of peer review (691 charts). Faculty emphasis for charting remained uniform throughout the study. During ten 1-hour sessions, pediatric residents reviewed the charts of their colleagues for comprehensive care and other measurements using a standard form. Although faculty were not present, residents reported by post-study interview that vigorous discussion and peer pressure occurred during the sessions, and subjectively they felt their charting had improved. An objective assessment indicated charting of past medical history worsened after peer review was initiated, and charting of family history improved slightly. All changes were marginal. Charting was not related to the volume of patients seen by individual residents or their level of training but was relatively consistent for individual residents over successive rotations.