University of Washington, Seattle, WA, USA.
VA Puget Sound Health Care System, Seattle, WA, USA.
BMC Med Educ. 2022 Jul 29;22(1):581. doi: 10.1186/s12909-022-03652-9.
There is significant variability in the performance and outcomes of invasive medical procedures such as percutaneous coronary intervention, endoscopy, and bronchoscopy. Peer evaluation is a common mechanism for assessment of clinician performance and care quality, and may be ideally suited for the evaluation of medical procedures. We therefore sought to perform a systematic review to identify and characterize peer evaluation tools for practicing clinicians, assess evidence supporting the validity of peer evaluation, and describe best practices of peer evaluation programs across multiple invasive medical procedures.
A systematic search of Medline and Embase (through September 7, 2021) was conducted to identify studies of peer evaluation and feedback relating to procedures in the field of internal medicine and related subspecialties. The methodological quality of the studies was assessed. Data were extracted on peer evaluation methods, feedback structures, and the validity and reproducibility of peer evaluations, including inter-observer agreement and associations with other quality measures when available.
Of 2,135 retrieved references, 32 studies met inclusion criteria. Of these, 21 were from the field of gastroenterology, 5 from cardiology, 3 from pulmonology, and 3 from interventional radiology. Overall, 22 studies described the development or testing of peer scoring systems and 18 reported inter-observer agreement, which was good or excellent in all but 2 studies. Only 4 studies, all from gastroenterology, tested the association of scoring systems with other quality measures, and no studies tested the impact of peer evaluation on patient outcomes. Best practices included standardized scoring systems, prospective criteria for case selection, and collaborative and non-judgmental review.
Peer evaluation of invasive medical procedures is feasible and generally demonstrates good or excellent inter-observer agreement when performed with structured tools. Our review identifies common elements of successful interventions across specialties. However, there is limited evidence that peer-evaluated performance is linked to other quality measures or that feedback to clinicians improves patient care or outcomes. Additional research is needed to develop and test peer evaluation and feedback interventions.
经皮冠状动脉介入治疗、内镜检查和支气管镜检查等侵袭性医疗程序的表现和结果存在显著差异。同行评估是评估临床医生表现和护理质量的常见机制，并且可能非常适合评估医疗程序。因此，我们试图进行系统评价，以确定和描述适用于执业临床医生的同行评估工具，评估同行评估的有效性证据，并描述多个侵袭性医疗程序中同行评估计划的最佳实践。
对 Medline 和 Embase 进行系统检索（截至 2021 年 9 月 7 日），以确定与内科及相关亚专科领域手术相关的同行评估和反馈研究。评估了研究的方法学质量。提取了关于同行评估方法、反馈结构以及同行评估的有效性和可重复性的数据，包括当有可用数据时的观察者间一致性和与其他质量措施的关联。
在检索到的 2135 篇参考文献中，有 32 篇符合纳入标准。其中，21 篇来自胃肠病学领域，5 篇来自心脏病学，3 篇来自肺病学，3 篇来自介入放射学。总体而言，22 项研究描述了同行评分系统的开发或测试，18 项研究报告了观察者间一致性，除了 2 项研究外，其余均为良好或优秀。只有 4 项研究，均来自胃肠病学，测试了评分系统与其他质量措施的关联，没有研究测试同行评估对患者结局的影响。最佳实践包括标准化评分系统、前瞻性病例选择标准以及协作和非评判性审查。
侵袭性医疗程序的同行评估是可行的，当使用结构化工具进行评估时，通常表现出良好或优秀的观察者间一致性。我们的综述确定了跨专业成功干预的共同要素。然而，同行评估的表现与其他质量措施相关联的证据有限，或者反馈给临床医生改善患者护理或结局的证据有限。需要进一步研究来开发和测试同行评估和反馈干预措施。
