Medical peer review

For the review of scholarly papers in refereed journals, see peer review.

For Physician peer review, see Physician peer review.

Medical peer review is the process by which a committee of physicians examines the work of a peer and determines whether the physician under review has met accepted standards of care in rendering medical services. Depending on the specific institution, a medical peer review may be initiated at the request of a patient, a physician, or an insurance carrier. The term "peer review" is sometimes used synonymously with performance appraisal.

The first documented description of a peer review process is found in the Ethics of the Physician written by Ishaq bin Ali al-Rahwi (854–931) of al-Raha, Syria, who describes the first medical peer review process. His work, as well as later Arabic medical manuals, states that a visiting physician must always make duplicate notes of a patient's condition on every visit. When the patient was cured or had died, the notes of the physician were examined by a local medical council of other physicians, who would review the practising physician's notes to decide whether his or her performance met the required standards of medical care. If their reviews were negative, the practicing physician could face a lawsuit from a maltreated patient.

The medical peer review committee

The objective of a medical peer review committee is to investigate the medical care rendered in order to determine whether accepted standards of care have been met. The professional or personal conduct of a physician or other healthcare professional may also be investigated. If a medical peer review committee finds that a physician has departed from accepted standards, it may recommend limiting or terminating the physician's privileges at an institution. Remedial measures including education may also be recommended.

In hospitals, only a peer review committee authorized by the physician medical staff is authorized to take action regarding a physician's medical privileges at that institution. A committee convened by the hospital administration or other group within the hospital may make disciplinary recommendations to the physician medical staff.

Departmental peer review committees are composed of physicians, while hospital-based performance-appraisal and systems-analysis committees may include nurses or administrators with or without the participation of physicians.

Nursing and other healthcare professionals also need to participate in Peer Review. In Nursing, as in other professions, peer review is an essential part of the maintaining professional control over practice, and a process that professionals use to hold themselves accountable for their services to the public and the organization. Peer review plays an essential role in assuring quality outcomes, fostering practice development, and maintaining professional autonomy. Being a professional requires involvement in self-regulation and peer review.The American Nurses Association guidelines on peer review define peer review as the process by which practitioners of the same rank, profession, or setting critically appraise each other’s work performance against established standards. This philosophy positions professionals, who are best acquainted with the requirements and demands of the role, as the givers and receivers of the feedback review.

Medical boards as peer review committees

State medical boards conduct peer review of licentiates. In some states, boards are composed of physicians; in other states, the medical board may include attorneys and other non-physicians. Physicians are part of the board in primarily advisory capacities. Under this structure, the medical board asks for a medical peer review by a committee of physicians that may or may not be part of the panel of physicians serving as advisors to the board.

Other state boards are run primarily by physicians from that state. In these states, peer review committees may be made up of members of the board solely, or by a committee selected from a panel of physicians not affiliated with the board. Decisions regarding physician licensure are recommended by the medical peer review committee to the board, which rejects or accepts the committee's recommendations.

Abuse

Main article: Sham peer review

Controversy exists over whether medical peer review has been used as a competitive weapon in turf wars among physicians, hospitals, HMOs, and other entities. Abuse is referred to as "sham peer review" by those who consider it endemic, and they allege that the creation of the National Practitioner Data Bank under the 1986 HCQIA facilitates such abuse, creating a 'third-rail' or a 'first-strike' mentality instead of an attempt to protect patients.

Defenders of the Health Care Quality Improvement Act state that the National Practitioner Data Bank protects patients by helping preventing errant physicians who have lost their privileges in one state from traveling to practice in another state.

See also: Specialty medical peer review, Utilization review, Utilization management, Sham peer review, and subpoena duces tecum

In response to the Health Care Quality Improvement Act of 1987, (HCQIA) (P.L. 99-660 ) executives of national medical associations and health care organizations formed a non-profit corporation to provide independent assessment of the quality of medical care by eminent physicians and surgeons. The American Medical Foundation for Peer Review and Education provide physician and medical staff peer review, specialty department assessment and entire hospital quality of care evaluation for over 2,000 of the nation's community and academic hospitals. Its "Foundation for Advanced Medical Education" developed a template with a $2 million dollar grant and six specialty societies to help physicians learn how to use new procedures and devices in a more comprehensive way.[citation needed]

See also