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

Abstract

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 bestpracticeadoption. 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 [interquartile 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.