 |
 |
|
1 April 1993 | Volume 118 Issue 7 | Pages 550-556
Objective: Peer review often consists of implicit evaluations by physician reviewers of the quality and appropriateness of care. This study evaluated the ability of implicit review to measure reliably various aspects of care on a general medicine inpatient service.
Design: Retrospective review of patients' charts, using structured implicit review, of a stratified random sample of consecutive admissions to a general medicine ward.
Setting: A university teaching hospital.
Patients: Twelve internists were trained in structured implicit review and reviewed 675 patient admissions (with 20% duplicate reviews for a total of 846 reviews).
Results: Although inter-rater reliabilities for assessments of overall quality of care and preventable deaths (
Conclusion: For assessment of overall quality and preventable deaths of general medicine inpatients, implicit review by peers had moderate degrees of reliability, but for most other specific aspects of care, physician reviewers could not agree. Implicit review was particularly unreliable at evaluating the appropriateness of hospital resource use and the patient's readiness for discharge, two areas where this type of review is often used.
Author and Article Information
From the University of Michigan, Ann Arbor, Michigan; Emory University, Atlanta, Georgia.
MEDICINE AND PUBLIC ISSUES
Evaluating the Care of General Medicine Inpatients: How Good Is Implicit Review?
= 0.5) were adequate for aggregate comparisons (for example, comparing mean ratings on two hospital wards), they were inadequate for reliable evaluations of single patients using one or two reviewers. Reviewers' agreement about most focused quality problems (for example, timeliness of diagnostic evaluation and clinical readiness at time of discharge) and about the appropriateness of hospital ancillary resource use was poor ( 
0.2). For most focused implicit measures, bias due to specific reviewers who were systematically more harsh or lenient (particularly for evaluation of resource-use appropriateness) accounted for much of the variation in reviewers' assessments, but this was not a substantial problem for the measure of overall quality. Reviewers rarely reported being unable to evaluate the quality of care because of deficiencies in documentation in the patient's chart.
Requests for Reprints: Dr. Hayward: University of Michigan Medical Center, Division of General Medicine, 3116 Taubman Center, Ann Arbor, MI 48109-0376.
Acknowledgments: The authors thank Clare Weipert for secretarial assistance; Judith Rosevear for data management; and Drs. Haya Rubin and Avedis Donabedian and Lisa Rubenstein for their advice and insights.
Grant Support: In part, by a grant from The John A. Hartford Foundation, Inc.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  H. M. Krumholz Seeking Better Outcomes in Coronary Artery Bypass Grafting: Lessons From Past Experience Circulation, June 10, 2008; 117(23): 2963 - 2965. [Full Text] [PDF]
|
|
|
|
|
|
V. Guru, J. V. Tu, E. Etchells, G. M. Anderson, C. D. Naylor, R. J. Novick, C. M. Feindel, F. D. Rubens, K. Teoh, A. Mathur, et al. Relationship Between Preventability of Death After Coronary Artery Bypass Graft Surgery and All-Cause Risk-Adjusted Mortality Rates Circulation, June 10, 2008; 117(23): 2969 - 2976. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. H. Thom, R. L. Kravitz, S. Kelly-Reif, R. V. Sprinkle, J. R. Hopkins, and L. V. Rubenstein A new instrument to measure appropriateness of services in primary care Int. J. Qual. Health Care, April 1, 2004; 16(2): 133 - 140. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Bindels, A. Hasman, J. W. J. van Wersch, P. Pop, and R. A. G. Winkens The Reliability of Assessing the Appropriateness of Requested Diagnostic Tests Med Decis Making, January 1, 2003; 23(1): 31 - 37. [Abstract] [PDF]
|
|
|
|
 |
|
 D. P. Scanlon, M. Chernew, H. E. Doty, and D. G. Smith Options for Assessing PPO Quality: Accreditation and Profiling as Accountability Strategies Med Care Res Rev, December 1, 2001; 58(4_suppl): 70 - 100. [Abstract] [PDF]
|
|
|
|
 |
|
 R. A. Hayward and T. P. Hofer Estimating Hospital Deaths Due to Medical Errors: Preventability Is in the Eye of the Reviewer JAMA, July 25, 2001; 286(4): 415 - 420. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. L. Rosenberg and C. Watts Patients Readmitted to ICUs* : A Systematic Review of Risk Factors and Outcomes Chest, August 1, 2000; 118(2): 492 - 502. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L.-M. Baldwin, L. G. Hart, R. E. Oshel, M. A. Fordyce, R. Cohen, and R. A. Rosenblatt Hospital Peer Review and the National Practitioner Data Bank: Clinical Privileges Action Reports JAMA, July 28, 1999; 282(4): 349 - 355. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Wu and C. M. Ashton Chart Review: A Need for Reappraisal Eval Health Prof, June 1, 1997; 20(2): 146 - 163. [Abstract] [PDF]
|
|
|
|
 |
|
 R. R. Owen, K. Rost, J. Hollenberg, J. B. Humphrey, M. Lazoritz, J. Bartlett, and G. R. Smith Effectiveness of Care and Improvement in Quality of Life in Patients With Panic Disorder Eval Rev, June 1, 1997; 21(3): 405 - 416. [Abstract] [PDF]
|
|
|
|
 |
|
 C. M. Helms and D. S. Wakefield Developing a Cooperative Provider-Based Statewide Peer Review Service: Early Experience American Journal of Medical Quality, March 1, 1996; 11(1): 46 - 50. [Abstract] [PDF]
|
|
|
|
 |
|
 J. W. Ely Physicians' Mistakes: Will Your Colleagues Offer Support? Arch Fam Med, February 1, 1996; 5(2): 76 - 77. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Kazmers Outcome After Surgery: An Evolving Concept Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 1995; 8(1): 109 - 128. [PDF]
|
|
Article
