NO CONFLICT OF INTEREST TO DECLARE. Can peer review improve quality?. David Smith. Peer review origin?. Ethics of the Physician Ishaq bin Ali al-Rahwi (854–931) of Syria.
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Ethics of the Physician
Ishaq bin Ali al-Rahwi (854–931) of Syria
All Quality Assurance programmes seem to rely ultimately on peer review, often in the form of an expert panel, to set the standards and the limits of acceptability.
Peer reviews are conducted by three trained assessors, two from the same speciality as the doctor being assessed, with one lay assessor and include:
Given the magnitude of the resources devoted to quality assurance and the centrality of peer assessment to these efforts, the results of this literature analysis indicate the need for a global reexamination of the peer review process.
Several of the proposals discussed herein appear to have considerable potential for improving the reliability of peer judgments.
Research directed at evaluating this potential should be part of the overall reassessment of peer review.
Goldman RL JAMA. 1992;267:958-960
physician agreement regarding quality of care is only slightly better than the level expected by chance.
Goldman RL JAMA. 1992;267:958-960
The screening process also must be more accurate in order to be cost-effective, as it was only slightly better than random sampling at correctly identifying below standard care. More reproducible physician review is also needed and might be accomplished through
Rubin et al JAMA 1992;267:2349-2354
The Process of Peer Review in U.S. Hospitals
Marc T. Edwards & Evan M. Benjamin
JCOM 2009 Vol. 16;10 461-467
Conclusions. When 2 physicians discuss a record that they are reviewing, it substantially improves the agreement between those 2 physicians. However, this improvement is illusory, as discussion does not improve the overall reliability as assessed by examining the reliability between physicians who were part of different discussions.
Hoper TP et al Medical Care 2000, 38:2 152-161
Surrogate markers of quality
May be ill founded
May be biased
Open to interpretation
Guidelines published in the peer-reviewed medical literature during the past decade do not adhere well to established methodological standards. While all areas of guideline development need improvement, greatest improvement is needed in the identification, evaluation, and synthesis of the scientific evidence.
431 guidelines were eligible for the study. Most did not meet the criteria
Despite improvement over time, the quality of practice guidelines developed by specialty societies is unsatisfactory.
Explicit methodological criteria for the production of guidelines shared among public agencies, scientific societies, and patients' associations need to be set up.
Recommendations issued in current ACC/AHA clinical practice guidelines are largely developed from lower levels of evidence or expert opinion.
The proportion of recommendations for which there is no conclusive evidence is also growing.
These findings highlight the need to improve the process of writing guidelines and to expand the evidence base from which clinical practice guidelines are derived
Historical ‘no holds barred’ case review is an exemplar of peer review but to be rigorous it needs a systematic format and a written record
A prospective study of colonoscopy practice in the UK today: are we adequately prepared for national colorectal cancer screening tomorrow?
C J A Bowles
GUT 2004 53 277-283
Increasingly robust risk adjusted outcome data
Local systematic egalitarian case review arrangements
2006 data: Ludman today: are we adequately prepared for national colorectal cancer screening tomorrow?Number of PCIs performed in 2006
Centres performing < 200 procedures
PCI program start date