Improving peer review: alternatives to unstructured judgments by a single reviewer

The Joint Commission Journal on Quality Improvement
R L Goldman, E Ciesco

Abstract

Peer review, usually involving unstructured judgments by a single peer reviewing medical records, was the backbone of quality management in health care organizations until recent years. Although other approaches to quality management, such as continuous quality improvement, are now being widely adopted, peer review can still play a role in identifying dysfunctional organizational processes and individuals delivering poor care. Given the questionable reliability and validity of peer review as usually practiced, however, a more rigorous and thoughtful approach is needed-with consideration of issues such as the number of peers involved, the nature of their interaction while forming judgments, and the type of assessment instruments they use. MULTIPLE-REVIEWER PROCEDURES: Such procedures include the use of two or more reviewers making their assessments independently, discussion to consensus among reviewers, and committee review. A number of studies suggest that instruments that carefully guide the reviewer have higher interrater reliability than less structured instruments. The focus of peer review can be expanded beyond individual practitioner performance to include assessment of the operational environment in which the clinician f...Continue Reading

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Citations

Apr 5, 2002·Journal of the American Academy of Nurse Practitioners·S L SheahanM K Rayens
Jul 26, 2003·Journal for Healthcare Quality : Official Publication of the National Association for Healthcare Quality·Diane Storer BrownCindy Serway
Mar 24, 2010·Physiotherapy Research International : the Journal for Researchers and Clinicians in Physical Therapy·Ta-Mera RollandMarion Jones
Jul 28, 2010·Clinical Obstetrics and Gynecology·Susan Mann, Stephen Pratt
Aug 14, 2009·Journal of Evaluation in Clinical Practice·Amanda Wheeler
Feb 14, 2003·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Rianne BindelsRon A G Winkens

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