Quality-of-Care Assessment: Choosing a Method for Peer Review

Abstract To evaluate the procedures used to assess quality of care, five peer-review methods were compared. These methods involved judgments based on two kinds of data: what physicians did for the patients (process); and what happened to the patients (outcome). Criteria used to make judgments were either predetermined by group consensus (explicit), or selected subjectively by individual reviewers (implicit). The care of 296 patients with urinary-tract infection, hypertension or ulcerated gastric or duodenal lesions was reviewed with use of the five methods. Depending on the method, from 1.4 to 63.2 per cent of patients were judged to have received adequate care. Judgment of process using explicit criteria yielded the fewest acceptable cases (1.4 per cent). The largest differences found were between methods using different sources of data. Thus, medical care, judged with implicit criteria, was rated adequate for 23.3 per cent of patients when process, and 63.2 per cent when outcome was used. (N Engl J Med ...