A Systematic Approach to Clinical Peer Review in a Critical Access Hospital

• Published in: Quality management in health care Vol. 25; no. 4; p. 213
• Main Authors: Deyo-Svendsen, Mark E, Phillips, Michael R, Albright, Jill K, Schilling, Keith A, Palmer, Karl B
• Format: Journal Article
• Language: English
• Published: United States 01.10.2016
• Subjects: Algorithms; Hospital Administration - methods; Hospital Mortality; Humans; Inservice Training; Medically Underserved Area; Peer Review - methods; Quality Improvement - organization & administration; Terminal Care - organization & administration
• ISSN: 1550-5154
• DOI: 10.1097/QMH.0000000000000113

Clinical provider peer review (CPPR) is a process for evaluating a patient's experience in encounters of care. It is part of ongoing professional practice evaluation and focused professional practice evaluation-important contributors to provider credentialing and privileging. Critical access hospitals are hindered in CPPR by having a limited number of providers, shortages of staff resources, and relationships among staff members that make unbiased review difficult. Small departments within larger institutions may face similar challenges. A CPPR process created at Mayo Clinic Health System is described. It involved a case review questionnaire built on the Institute of Medicine "Six Aims for Changing the Health Care System," a standardized intervention algorithm and tracking tool. During 2007 through 2014, a total of 994 cases were reviewed; 31% led to provider dialog and education or intervention. Findings were applied to core measure processes with success rate going from 87% to 97%. Changes were adopted in end-of-life care, contributing to a 50% reduction in all-cause mortality rate. Providing peer review tools to a critical access hospital can keep peer review within a group with knowledge of the individual provider's practice and can make process improvement the everyday work of those involved.