In pursuit of quality and safety: an 8-year study of clinical peer review best practices in US hospitals.

OBJECTIVES

Gather normative data on the goals of clinical peer review; refine a best-practice model and related self-assessment inventory; identify the interval progress towards best-practice adoption.

DESIGN

Online survey (2015-16) of a cohort of 457 programs first studied by volunteer sampling in either 2007 or 2009 on 40 items assessing the degree of conformance to a validated quality improvement (QI) model and addressing program goals, structure, process, governance, and impact on quality and safety.

SETTING

Acute care hospitals of all sizes in the USA.

STUDY PARTICIPANTS

Physicians and hospital leaders or hospital staff with intimate program knowledge.

INTERVENTION

None.

MAIN OUTCOME MEASURES

Subjectively-rated program impact on quality and safety; QI model score.

RESULTS

Two hundred and seventy responses (59% response rate) showed that clinical peer review most commonly aims to improve quality and safety. From 2007 to 2015, the median [inter-quartile range, IQR] annual rate of major program change was 20% [11-24%]. Mean [confidence interval, CI] QI model scores increased 5.6 [2.9-8.3] points from 46.2 at study entry. Only 35% scored at least 60 of 80 possible points-'C' level progress in adopting the QI model. The analysis supports expansion of the QI model and an associated self-assessment inventory to include 20 items on a 100-point scale for which a 10-point increase predicts a one level improvement in quality impact with an odds ratio [CI] of 2.5 [2.2-3.0].

CONCLUSIONS

Hospital and physician leaders could potentially accelerate progress in quality and safety by revisiting their clinical peer review practices in light of the evidence-based QI model.