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Integration of radiologist peer review into clinical review workstation.

Professional peer review of random prior radiologist's interpretations is mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The JCAHO expects documentation of 5% rate of random peer-review cases. Countless hours are spent in departments fulfilling these requirements. The integration of the peer-review process into the radiologist's interpretation workflow was expected to increase the percentage of documented peer review, yet decrease the time and effort for this documentation. radStation clinical review workstations are deployed at every reading station. When a requisition is bar-coded, radStation retrieves the patient's clinical information and automatically displays the prior comparison report. If the radiologist agrees with the prior report, a single click on a "quality assurance' agree box documents the agreement. In the case of a discordance, an additional dialog box automatically appears and the radiologist enters the reason for disagreement and then submits the case as a discrepancy. The system holds the discordance for 3 to 5 working days, then notifies the original radiologist via E-mail that a prior interpretation has been submitted for peer review, lists the submitted discrepancy reason, and provides a link to display the discordant report. The peer-review database is separate from the existing radiology information system (RIS). At the end of every month, summary reports of all peer-review activity are generated automatically. Initial benchmarks of our deployed system anticipate documentation of long-term random peer-review rate at greater than 50% of interpreted cases. The system enhances the peer-review process by integrating it with the normal interpretation workflow. The time to complete peer review using radStation is less than 1 second per normal case and less than 60 seconds for a discordant case. The E-mail notification system is fully automated, eliminating the need for secretarial involvement in the data collection. This system has completely replaced a manual paper-based system. The integration of peer review directly into the radiologist's interpretation workstation greatly enhances the capability to easily exceed JCAHO standards. The overall increase in peer-review documentation should continue to improve the ability to document a consistent high quality of patient care.

Computer Communication Networks↗

Reviewers' perceptions of the peer review process for a medical education journal.

AIMS: To explore the review process from the reviewers' perspective, including perceptions of the time taken to carry out a review, barriers to and facilitators of the review process, benefits of reviewing, opinions about blinded versus transparent reviews, how the process of reviewing might be made easier, and to assess reviewers' experience of, and training in, the peer review process. SUBJECTS: Reviewers for Medical Education invited to review over a 5-month period between 1st June and 31st October 2002 (n = 221). METHODS: Postal questionnaire accompanying a request to review a manuscript. RESULTS: The overall response rate was 64.7% (the response rate of those completing and returning a manuscript review and a questionnaire was 87%); 30% were first-time reviewers for Medical Education, although the majority (87%) reviewed for other journals. The average time spent on the current review was just over 3 hours (184.3 minutes, median 162 minutes, range 30-810 minutes), which was stated to be about the same time as usual for the majority. Only 14% of respondents had received formal training in reviewing, although 66% said they would like such training. A total of 79.5% said they would have liked to seek a colleague's opinion, and 90% wished to receive other reviewers' comments. A wide range of problems with the review process were encountered, and the main way in which it was felt it could be made easier was to make the process electronic. Nearly three quarters of respondents said they would be happy to sign their reviews. Acting as a reviewer was seen as a professional responsibility and as an opportunity for learning. CONCLUSIONS: This study provides useful insights into the process of review from the reviewer's perspective. Reviewers spend a substantial amount of time on each paper. Many referees feel their reviews would benefit if they had formal training in the review process, received feedback on their reviews, or were able to ask colleagues for opinions on the paper being reviewed. Most reviewers would be willing to sign their reviews and feel that the process should be transparent. These results may help inform discussions about how to better prepare peer reviewers for their job.

Education, Medical, Undergraduate↗

Assessing peer review in the quest for improved medical services and the implications for education in quality assessment: Part IV.

Three court decisions reviewing medical peer review conducted in hospitals were discussed at length in part III of this article. In their opinions the courts gave at least tacit approval to the procedures followed in the hospitals, and they accepted that an evidentiary basis for adverse action against the physicians was present. But not all medical peer review in hospitals resulting in adverse actions is found satisfactory when challenged in court, and the most prominent litigation in the decade of the 1980s concerning medical peer review, Patrick v. Burget (1), is testimony to the potential for its perversion. Part II adverted to the potential for bias or lack of objectivity in assessing physician performance. Part I mentioned the problem of bias in the context of peer review of articles for publication and of research grant proposals. The objectives of Part IV are: (1) to examine the concern about bias in medical peer review and to indicate how it may be lessened, if not eliminated; (2) to address further the difficulty created by the relative lack of valid criteria to employ in medical peer review; (3) to review the extent of protection from liability afforded to participants in medical peer review; and (4) to describe the changes that should be anticipated in review of medical services in the future. Before addressing these subjects it is essential to remind the reader that medical peer review is not conducted primarily for disciplinary purposes; rather, its purpose is to evaluate the quality of care.(ABSTRACT TRUNCATED AT 250 WORDS)

Bias↗

Effects of editorial peer review: a systematic review.

CONTEXT: Editorial peer review is widely used to select submissions to journals for publication and is presumed to improve their usefulness. Sufficient research on peer review has been published to consider a synthesis of its effects. METHODS: To examine the evidence of the effects of editorial peer-review processes in biomedical journals, we conducted electronic and full-text searches of private and public databases to June 2000 and corresponded with the World Association of Medical Editors, European Association of Science Editors, Council of Science Editors, and researchers in the field to locate comparative studies assessing the effects of any stage of the peer-review process that made some attempt to control for confounding. Nineteen of 135 identified studies fulfilled our criteria. Because of the diversity of study questions, methods, and outcomes, we did not pool results. RESULTS: Nine studies considered the effects of concealing reviewer/author identity. Four studies suggested that concealing reviewer or author identity affected review quality (mostly positively); however, methodological limitations make their findings ambiguous, and other studies' results were either negative or inconclusive. One study suggested that a statistical checklist can improve report quality, but another failed to find an effect of publishing another checklist. One study found no evidence that training referees improves performance and another showed increased interrater reliability; both used open designs, making interpretation difficult. Two studies of how journals communicate with reviewers did not demonstrate any effect on review quality. One study failed to show reviewer bias, but the findings may not be generalizable. One nonrandomized study compared the quality of articles published in peer-reviewed vs other journals. Two studies showed that editorial processes make articles more readable and improve the quality of reporting, but the findings may have limited generalizability to other journals. CONCLUSIONS: Editorial peer review, although widely used, is largely untested and its effects are uncertain.

Peer Review, Research↗

How reliable is peer review? An examination of operating grant proposals simultaneously submitted to two similar peer review systems.

To determine level of agreement and correlation between two similar but separate peer review systems, proposals simultaneously submitted during the same funding year to two agencies using the same scoring system were identified and analyzed (n = 248). There was a direct linear relationship between the scores of the two agencies (r = 0.592, p < 0.001). Raw agreement within whole-digit ranges was moderate (53%) but a Cohen's kappa indicated that agreement beyond chance was only fair (kappa = 0.29, 95% CI = 0.198, 0.382). When proposals were arbitrarily categorized as being "clearly fundable" (on a 0-5 scale, score > or = 3.0) or "not clearly fundable" (score < 3.0), raw agreement was 73% and agreement beyond chance was moderate (kappa = 0.444, 95% CI = 0.382, 0.552). In cases where there was inter-agency disagreement on the fundability of the project, the difference in scores was greater than in those in which there was agreement. In a subsample of 128 pairs, variables describing the application and the applicant (i.e., principal investigator) were coded, but none explained inter-agency agreement on the "fundability" of proposals.

Humans↗

The Medical Journal of Australia Internet peer-review study.

BACKGROUND: Peer review of medical papers is a confidential consultancy between the reviewer and the journal editor, and has been criticised for its potential bias and inadequacy. We explored the potential of the internet for open peer review to see whether this approach improved the quality and outcome of peer review. METHODS: Research and review articles that had been accepted for publication in The Medical Journal of Australia (MJA) were published together with the reviewers' reports on the worldwide web, with the consent of authors and referees. Selected readers' e-mailed comments were electronically published as additional commentary; authors could reply or revise their paper in response to readers' comments. Articles were edited and published in print after this open review. FINDINGS: 60 (81%) of 74 authors agreed to take part in the study, together with 150 (92%) of 162 reviewers. There was no significant difference in the performance of commissioned reviewers before and during the study. Four articles were not included because of insufficient time before print publication. Of the remaining 56 papers, 28 received 52 comments from 42 readers (2% of readers submitted comments). Most readers' comments were short and specific, and seven articles were changed by the authors in response. INTERPRETATION: Open peer review is acceptable to most authors and reviewers. Postpublication review by readers on the internet is no substitute for commissioned prepublication review, but can provide editors with valuable input from individuals who would not otherwise be consulted. Readers also gain insight into the processes of peer review and publication.

Attitude↗

Legal issues raised by private review activities of medical peer-review organizations.

Increasingly, medical peer-review organizations are entering into contracts with insurance companies and self-insured employers to conduct utilization reviews and quality-of-care assessments. Such private review activities raise new legal issues, requiring analysis of state law as well as federal law. This paper analyzes several of the most important of these legal issues, and suggests some directions for peer-review organizations to take in order to avoid unnecessary legal problems.

Confidentiality↗

When reviews attack: ethics, free speech, and the peer review process.

The peer review process, whether formally applied in publication and grant review, or informally, such as exchange of ideas in scientific and professional newsgroups, has sparked controversy. Writers in this area agree that scholarly reviews that are inappropriate in tone are not uncommon. Indeed, commentators have suggested rules and guidelines that can be used to improve the review process and to make reviewers more accountable. In this paper, we examine the relevance and impact of ethical codes on the conduct of peer review. It is our contention that the peer review process can be improved, not by a new set of rules but through closer attention to the ethical principles to which we, as psychologists, already subscribe.

Canada↗