Peer Review of Medical Care

A study of judgments of the quality of clinical care, made after retrospective analyses of hospital charts, in three clinical disciplines (obstetrics, surgery, pediatrics), revealed discrepancies, in intra-disciplinary judgments of the quality of clinical care, that cast doubt on the validity and the reliability of uncontrolled peer judgments of this quality. It was demonstrated that the degree of agreement between repeat judgments on the same cases by the same reviewers did not materially differ from the agreement seen in a different study involving serial judgments of the same kind made by different reviewers. It was shown: (1) that individual judges consistently differed, in the degree of harshness or permissiveness of their respective judgments; 2. that judges depended upon different aspects of clinical care to make final judgments of the quality of that care, and 3. that the number of independent (but professionally equally qualified) judges required to reach a stable judgment of care quality exceeded the number logistically available to meet the probable future demands of third-party payors. It was suggested that judgments of the quality of clinical care, derived from retrospective analyses of hospital charts, should be related to the compliance (or noncompliance) of the recorded care with pre-established sets of standards for that care.