See also:
Peer Review, Confidentiality
Clinical Proctoring
Medicaid Services
Peer Review
The Academy believes that an effective peer review mechanism is an essential part of quality health care delivery. The membership is encouraged to actively participate in peer review programs at the state and local levels so that peer review can continue to be effectively developed on the basis of physician-established guidelines for each area which will conform more closely to local or state conditions and patterns of practice. In addition, family physician participation will insure the availability of an adequate supply of physicians to provide true peer review for other family physicians.
In order for meaningful peer review to take place, adherence to the following concepts is essential in the development of any guidelines:
In order for meaningful peer review to take place, adherence to the following concepts is essential in the development of any guidelines:
- Cost containment, while an important consideration, should not be allowed to negatively influence the quality of care afforded patients.
- Clinical policies for patient care should be established by practicing physicians based upon needs appropriate to the local area. Even though health care is provided under uniform standards of care, local circumstances and considerations may modify final interpretations as to whether or not a standard of care is met.
- Physician departure from clinical policies should not be interpreted as a breach of good medical practice. Such departures should be weighed individually, and during the review process, the physician providing the care should be given the opportunity to clarify the documented details of the clinical care rendered.
- Peer review should assess the quality of care rendered. Peer review should be performed by a physician with similar qualifications to those of the physician being reviewed.
- Criteria for hospital admission should not be on a diagnosis basis only, but should also be based on severity of illness, social factors and physical findings.
- Utilization review provided by a physician should be considered the most valid determiner of the correct diagnostic category. Only physician peers should determine the need for continued hospital stay and other quality issues during the peer review process.
- The end product of peer review should be improvement of patient care through physician education and health system improvement. (1988) (2006)
