C' Christopher Bremer, M'D'

1
Peer Review

• C. Christopher Bremer, M.D.
• Professor Emeritus, Family Medicine
• Brody School of Medicine at East Carolina
  University
• Greenville, North Carolina, USA

2
Peer Review is

• Peer Review is oversight by physicians of equal
  standing.
• Peer Review is the process by which physicians
  are reviewed
• by their colleagues
• from initial application process and for as
  long as they practice.

3
Peer Review Includes

• Evaluation of any cases which fall outside
  pre-the determined parameters
• Focused reviews of cases with bad outcomes or by
  request
• Corrective Action

4
Process in Brief

• Obtain data on performance
• Share it with physicians
• Review of the data by a peer
• Hold each physician accountable for his or her
  performance

5
Peer Review is NOT

• Only examination of cases with a bad outcome
• Only removing poor performers
• Only corrective action
• A risk management function

6
Continuous Learning

• Peer Review identifies Best Practice and notifies
  physicians how they are doing in relation to Best
  Practice.
• (Quarterly reports)

7
(No Transcript)
8
Peer Review Should Be

• Confidential and Transparent
• Collegial and Objective
• Data Driven
• Fair
• Ongoing
• Specialty Specific

9
The Process

• Identify Best Practice
• Identify How What to Measure
• Measure, Monitor, Generate Data

10
Identification of Best Practice

• National Guidelines
• Benchmarks from National Organizations
• Regional or Local Best Practices

11
Development of Indicators to Measure

• Both outcome-based and process-based
• Safety, clinical quality, service quality
• Single cases and trends
• Agreed upon by the physicians

12
Identification of Outliers

• Single cases
• Trends
• Focused review

13
Who Gets the Data?

• Peer Review Committee
• Chiefs of Service, Chief of Staff
• The individual physician

14
Feedback to the Chiefs

• Physician profiles and Chiefs quarterly
  reports
• Outliers identified and notified promptly
• Patient care issues when identified

15
Possible Action Plan for Outliers

• Committee on Physician Health
• notification and clarification of
  expectations
• Counseling
• Education

16
Possible Action Plan for Outliers

• Anger management
• Evaluation by a physician
• Evaluation by a psychiatrist
• Proctoring
• 100 case review

16
17
How Do We Do Peer Review ?

• Pitt County Memorial Hospital
• (teaching hospital for the Brody School of
  Medicine)

18
Indicator Selection

• Technical and Clinical Quality
• Patient safety
• Resource Use
• Interpersonal Interactions
• Citizenship
  Medical Records Completion

19
Indicator Selection (Six core competencies)

• Technical, Clinical Skills
• Medical, Clinical Knowledge
• Systems-Based Practice
• Clinical Judgment
• Interpersonal, Communication Skills
• Professionalism

20
Outliers

• Peer Review form (focused review)
• Cases reviewed Sentinel events, complaints,
  etc.
• Trends
• Profiles to Physicians
• Quarterly reports to Chiefs

21
Observations

• In the past 2 years Peer Review has become more
  clinical and more physician-specific
• In the past 2 years Peer Review processes have
  matured to functional levels
• Questions of optimum process remain.