Improving Peer Review: Alternatives to Unstructured Judgments by a Single Reviewer

Explicit versus implicit review to explore combination antipsychotic prescribing

“…Third, no consensus judgement could be reached for 10% of the cases, suggesting that perhaps more reviewers were needed, the rating instrument required further development or further training was required. The reliability of peer review is thought to be higher with more reviewers [29], hence the use of three reviewers in this study. Rubin et al.…”

“…Third, no consensus judgement could be reached for 10% of the cases, suggesting that perhaps more reviewers were needed, the rating instrument required further development or further training was required. The reliability of peer review is thought to be higher with more reviewers [29], hence the use of three reviewers in this study. Rubin et al found that using five independent reviewers per case achieved more than 90% accuracy, and while this is not practical in routine clinical practice, they suggested that some very complex cases may warrant this effort [28].…”

The Reliability of Assessing the Appropriateness of Requested Diagnostic Tests

“…15 In contrast with methods such as implicit and explicit review mentioned above, the physician is stimulated to follow the distributed practice guidelines on appropriate health care. Next, a reviewer or the decision support system checks whether the individual GP adheres to the guidelines and produces feedback if necessary.…”

“…14 An alternative is to increase the number of reviewers, with consensus meetings between independent reviewers or peer review committees. 15 Including multiple independent reviewers is responsible for the problem of low interrater agreement as mentioned above. The results of a discussion between physicians when reviewing medical information depends on the composition of the group and does not automatically improve the overall reliability of the judgment of physicians who take part in different panels.…”

Lessons in Redesigning a Quality Program Across the Continuum

“…Although NEB's productive work is accomplished through processes, many critical processes were not designed, but had instead evolved and been passed on to the next generation of workers. Identifying dysfunctional organizational processes became as important as i d e n w n g individuals delivering substandard care (Goldman & Ciesco, 1996;Wakefield & Helms, 1995).…”