Understanding the Peer-Review Process
The best peer-review processes facilitate continuous evaluation of a provider’s professional performance by other providers using the 6 core competencies endorsed by the Accreditation Council for Graduate Medical Education: patient care, medical knowledge, practice-based learning, interpersonal skills, professionalism, and system-based practice. Peer review is intended to improve patient care by promoting provider self-regulation in identifying and addressing opportunities in individual performance. The process includes providing resources and setting goals to help providers. Peer review also enables the identification and public review of cases that demonstrate excellent care. The sharing of these cases can inspire physicians who work with similar resources, as well as raise questions for further research.
Peer review is a continuous process that starts during medical school and continues during residency. Seeking and maintaining certification from the American Board of Obstetrics and Gynecology (ABOG) is part of this process. Those certified after 1986 must actively participate in the annual ABOG Maintenance of Certification process. In 2016, the American Board of Medical Specialties and the National Patient Safety Foundation encouraged each American Board of Medical Specialties member organization, including ABOG, to integrate safety principles and activities into their initial and continuous certification processes.
The peer-review process is also active when a provider applies for privileges at a new institution or requests privileges for a new activity. Again, the goal is to ensure that the provider can safely perform the requested privileges.
Both the Centers for Medicare and Medicaid Services and the Joint Commission require hospitals to track the performance of all privileged providers. This component of peer review comprises 2 phases in which an oversight committee reviews both quantitative and qualitative data. Bias should be minimized by including members from different departments and professions (eg, hospitalists, obstetrician and gynecologists, midwives, nurses), ensuring training of committee members, maintaining a consistent committee membership, having a reliable written process, and ensuring consistent oversight of the committee’s functioning.
The first phase is Ongoing Professional Practice Evaluation, which involves the systematic collection and review of individual provider data. Different models of review can be used. The case review model of a single discipline includes the typical morbidity and mortality conference and review of medical errors, adverse patient events, and patient complaints. The multidisciplinary case review model engages representatives of different specialties who care for similar patients. The data/registry review model provides objective data and triggers to evaluate the quality of care. The best peer-review processes incorporate all these models. This phase informs other processes, such as recredentialing committees.
When Ongoing Professional Practice Evaluation or colleagues identify potential performance concerns, the second phase, Focused Professional Practice Evaluation, becomes necessary. This phase often includes in-depth, targeted data collection to make an objective assessment of provider performance. It may also include direct peer observation of a determined number of cases/procedures. When concerns are validated, an improvement plan, often including education and direct proctoring, is developed to assist the provider. Focused Professional Practice Evaluation is also used when any new privilege is granted to a provider or after a certain period following hiring of new staff to ensure competency.
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Shivraj P, Novak A, Aziz S, Larsen W, Ramin S. The certification process driving patient safety. Obstet Gynecol Clin North Am. 2019;46(2):269-280. PMID: 31056129
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