Honor codes and peer review--is peer review really possible?
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Education, Dental↗
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Results for “Peer Review”
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Peer review--the West Australian experience. The West Australian Peer Review Sub-Committee.
In view of the Department of Health's recommendations that Peer Review be accepted as an integral part of the medical system, local members of the college volunteered to take part in a pilot study. Those involved were divided into three groups and were left to devise their own system. Following subsequent discussion and assessment, a workable scheme evolved as described. This system employs a 'rolling' or an ongoing technique in which a group of four psychiatrists form the peer review group. Following each assessment a new member joins the team and the longest serving person is assessed before leaving. The problems and difficulties of peer review are discussed and the importance of the link between peer review and continuing education is stressed.
Australia↗
Peer review. A study commissioned by the Federal Council of the Australian Medical Association of peer review systems in the United States of America, Canada and West Germany.
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Accreditation↗
Peer review & record review systems.
This paper describes the implementation of both peer review and record review systems as initiated at the University Hospitals of Cleveland occupational therapy department. Peer review evaluations can be used to ascertain a therapist's need for continuing education in a specific area, to evaluate and improve standards of practice, to gather statistics on professional objectives, and to develop Professional Standards Review Organization criteria. The system of peer review stimulated an improvement in documentation of services provided by occupational therapists, as well as in critical self-awareness of individual strengths and weaknesses. A separate method of record review was instituted to provide a basis for evaluating individual performance for either recognition or disciplinary purposes. Unlike peer review, record review results become incorporated into the therapist's personnel record.
Hospital Departments↗
Peer review: accountability and legal implications.
In summary, increasingly accountability implies the acceptance of peer review as an integral part of nursing practice. Peer review in turn presents a variety of ethical and legal implications and, beyond the scope of this discussion, educational, organizational and psychological implications as well. We must proceed to identify the components necessary to a sound peer review approach, starting with ethical issue and the necessary data base to measure outcomes of care right through the mechanisms of process and structural arrangements. Then, of course, we must ensure the application of rigorous examination of results. Whether QAPs as a whole or peer review as a specific, results are not dependent solely on the provider and client. Environmental and organizational factors must also be considered. Outcomes of care and performance are a function of the interaction of a variety of factors. In essence, the onus for assuring that the profession will meet its public accountability rests largely with each and every one of us. Every professional practitioner in the context of peer review will be compelled to be involved in assessment of the many dimensions of patient care. If professional self-requlation is to be effective, all professional nurses must be involved. In sum, we are the ones who must determine the what and the how of accountability for the nursing profession.
Ethics, Nursing↗
Psychiatric peer review: a working model.
The author describes a system for psychiatric peer review developed by a peer review committee in a general hospital. At the heart of the system is a form called the peer review check sheet, which requires the physician to specify diagnosis, reasons for hospitalization, and major symptom complexes, as well as laboratory work and treatment and discharge plans. Minimal criteria have been established to verify the diagnoses and to justify the need for hospitalization. Each month the check sheets are removed from the charts of patients who have been discharged and sent to committee members for evaluation. Those that are incomplete or unsatisfactory signal the need to examine the patient's chart.
Feedback↗
Peer review for nonphysicians.
The inclusion of nonphysician health care practitioners in hospital quality assurance programs is being called for by the new JCAH standards and PSRO regulations/PSRO guidelines require that nonphysicians be reviewed by peers.
Health Occupations↗
Peer review organization payment denials: comparative analysis of emergency department and non-emergency-department admissions.
The Health Care Financing Administration has contracted with regional peer review organizations to review Medicare admissions and to deny payment for hospital admissions that fail to meet peer review organization criteria. The purpose of this study was to compare emergency department admissions with non-emergency-department admissions with respect to rates of peer review organization denial and the reasons for those denials. All hospital Medicare admissions between January 1984 and April 1987 were retrospectively reviewed. Patients were excluded if they received peer review organization pre-authorization prior to admission. The rest were classified by 1) source of admission (emergency department or non-emergency department), 2) peer review organization decision, 3) reason for peer review organization denial, 4) whether the denial was appealed, 5) the results of appeal. Chi-square or Fisher's Exact Test analysis was performed, and P less than 0.05 was considered to be significant. During the 40-month study period, there were 19,847 emergency department Medicare admissions and 19,752 non-emergency-department Medicare admissions. Of the non-emergency-department admissions, 7887 received pre-authorization. None of the emergency department admissions received pre-authorization. Of the 19,847 emergency department admissions, 433 (2.23%) were denied. Of these denials, 269 (60.7%) were appealed by the hospital; 136 (50.5%) successfully. Of the 11,865 non-emergency department, non-pre-authorized admissions, 333 (2.81%) were denied. Of these denials, 174 (52.2%) were appealed, 76 (43.6%) successfully. Overall, emergency department admissions were significantly less likely to receive peer review organization denial than non-emergency-department, non-pre-authorized admissions (P less than 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)
Centers for Medicare and Medicaid Services, U.S.↗
Artificial Intelligence Cannot Replace Peer Reviewers but May Help Editors Triage: A Comparative Analysis of a Large Language Model and Human Reviewer Recommendations at the American Journal of Sports Medicine.
BACKGROUND: The peer review system faces increasing strain from rising manuscript volumes, reviewer fatigue, and well-documented interreviewer disagreement. Large language models (LLMs) have shown potential to support the peer review process, but their ability to replicate editorial decisions at high-impact medical journals and their utility as manuscript screening tools remain unknown. PURPOSE: To compare the agreement between an LLM and the final editorial decision on manuscripts submitted to the American Journal of Sports Medicine and to evaluate the potential of LLMs as a manuscript screening tool. STUDY DESIGN: Cross-sectional agreement study. METHODS: Fifty-four manuscripts randomly selected from submissions to the American Journal of Sports Medicine (September 2024-October 2024) were reviewed by a locally deployed LLM (Ministral 3 14B; Mistral AI) using a standardized prompt. The artificial intelligence (AI) produced a categorical recommendation (reject, cascade, revision, or accept) and a numerical score (0-100) for each manuscript. Agreement with the final editorial decision was assessed by Cohen kappa (4-category model) for pooled human reviewers (n = 139 reviews) and the AI (n = 54). Screening performance was evaluated by positive predictive value (PPV), sensitivity, and specificity. RESULTS: Pooled human reviewers demonstrated fair agreement with the final decision (κ = 0.181 [P < .001]; 42.4% agreement), while the AI demonstrated slight, nonsignificant agreement (κ = 0.126 [P = .099]; 37.0% agreement). The AI recommended revision for 61.1% of manuscripts, of which 72.7% were ultimately rejected or cascaded, demonstrating systematic "revision bias." When the AI recommended rejection, 54.5% of those manuscripts were ultimately rejected and 27.3% were cascaded; when the AI recommended cascade, 50% were rejected and 50% were cascaded. However, when the AI recommended rejection or cascade (n = 21), 90.5% received a final decision of rejection or cascade (PPV, 90.5%; specificity, 81.8%). Manuscripts with an AI score <70 were rejected or cascaded 88.0% of the time (PPV, 88.0%). CONCLUSION: AI cannot replicate the nuanced judgment of human peer reviewers at a high-impact sports medicine journal. When AI recommended rejection or cascade, 90.5% of manuscripts received that final decision (descriptive PPV, 90.5%; 95% CI, 71.1%-97.3%), suggesting potential utility as an exploratory first-pass screening tool warranting further validation in larger cohorts. However, AI could not reliably distinguish manuscripts destined for outright rejection from those that would be cascaded to a sister journal-an important limitation for editorial triage applications.
Sports Medicine↗
Peer review as a quality assurance mechanism in three pharmacist-run medication-refill clinics.
A peer-review system for monitoring pharmacists' practice in medication-refill clinics is described. Pharmacist practitioners trained in pharmacology, therapeutics, and physical assessment provide services in three medication-refill clinics associated with a 350-bed Department of Veterans Affairs (VA) medical center. The clinics serve patients who have exhausted their prescribed drugs before their next appointment with a physician. During a clinic visit, the pharmacist assesses the patient and the drug therapy and either consults an attending physician or writes new prescriptions. The pharmacist documents his or her activities in the medical record. The peer-review mechanism involves quarterly audits in which the chart notes written by the pharmacists are reviewed by other pharmacists. Five indicators of the quality of care are used in the peer reviews. The results are presented to the ambulatory-care and quality assurance pharmacy committees for analysis and discussion. The peer-review system has resulted in better compliance by the pharmacists with the quality indicators and clinic procedures, suggesting that the quality of care has also benefited. Peer review is used successfully to evaluate and monitor the care provided by pharmacists in medication-refill clinics associated with a VA medical center.
California↗
Establishing guidelines for peer review of the clinical dietitian.
Guidelines for peer review of clinical dietitians are needed. In this study, two areas relevant to such guidelines, i.e., data useful in assessing nutritional status of patients and written communications of the dietary staff with other health care staff, were explored. Admission height and weight and blood chemistries, as found on dietary cards for 119 randomly selected patients during 1973, were tabulated. In addition, pertinent information on dietary cards and in the medical records was compared. The findings indicated that the biochemical and anthropometric indicators of nutritional status were available in the medical records but were not being utilized by dietitians to the degree expected. The dietary card is the logical focus for peer review, but better documentation is needed in areas of dietary history recording, computation of ideal weights, utilization of laboratory data, and development of nutritional care plans.
Blood Proteins↗
Peer review of group therapy: Washington, D.C., 1972-1977.
The author discusses the evolution of psychiatric peer review in Washington, D.C. In its first six years (1972-1977) the Washington Psychiatric Society Peer Review Committee evaluated 146 cases, 23 (16%) of which focused on group therapy. Eight of these cases (35%) were partially or fully denied. Most of the cases involved outpatients with neuroses or character disorders who were treated in combined group and individual therapy. The author presents specific cases illustrating group therapy issues and peer review decisions. He discusses the benefits and liabilities of peer review and emphasizes its importance as a flexible, clinically sensitive, confidential, and meaningful process.
District of Columbia↗
Planning a peer review program.
The purpose of this study was to provide a basis for the planning and subsequent implementation of a peer review program, concomitant to exploring the perceptions of registered nurses regarding initiating a peer review program in a small midwestern hospital. The study findings indicated that registered nurses liked the peer review process, perceived peer review as helping their professional growth, and indicated a strong desire for education and in-service. Based on the study results, planning and recommendations for further implementation are discussed.
Attitude of Health Personnel↗
Attitides towards peer review.
The Australian Commonwealth Minister for Health called on the Australian Medical standards in Australia. Among the initial responses of the AMA was the organization of a National Seminar of Peer Review. Participants were asked to identify questions they would like to have answered about peer review and about aspects of a peer review system which they would perceive as necessary for its acceptability. Responses to these questions are analyzed and discussed. Implications for the introduction of peer review in Australia are examined, and strategies for gaining the commitment of the profession to the implementation of peer review are suggested.
Attitude of Health Personnel↗
Use, costs, and quality of medical services: impact of the New Mexico peer review system. A 1971-1975 study.
To assess the effect of areawide peer review (such as that conducted by Professional Standards Review Organizations [PSROs]) on use, cost and quality of medical services, we evaluated 4 years of data on the efforts of the New Mexico Experimental Medical Care Review Organization in reviewing medical services for the Medicaid population. Utilization review had no demonstrable impact on hospital use; hospital days per 100 eligible persons rose 5.0% and 43.4% for persons enrolled all 4 years in Aid to Families with Dependent Children (AFDC) and Aid to the Permanently and Totally Disabled, respectively. Peer review produced no net dollar savings; over 4 years, the amount paid for all services per AFDC-eligible person rose 85%. Peer review improved the quality of ambulatory care through large reductions (75%) in medically unnecessary injections. If these findings are replicated elsewhere, they suggest that the goal of the PSRO program to control costs by curtailing utilization may be difficult to achieve, the quality of care goal may be pursued successfully, and the PSRO mission should be focused more on the latter.
Ambulatory Care↗
Evaluation of TRISS as a means of selecting trauma deaths for clinical peer review.
This study was carried out to evaluate the predictive power of a mathematical model called TRISS in identifying avoidable trauma deaths when compared with peer review (PR). The subjects studied comprised the 24 deaths that occurred among 81 severely injured patients (Injury Severity Score greater than or equal to 16) admitted to a trauma unit over a 1 year period. Sixteen patients who had a greater than 50% probability of survival (Ps) calculated by TRISS died. Peer review concluded that five of those were potentially avoidable deaths. Eight deaths occurred in patients with a Ps less than 50%. Peer review regarded those eight as inevitable deaths. The data, when analysed, showed TRISS to have a 100% sensitivity, 42% specificity, 31% positive predictive value and a negative predictive value of 100% when compared with peer review. It is concluded that TRISS tends to over-estimate potentially avoidable death, especially in patients with severe head injury. However it is a good audit filter as it reliably excludes inevitable death.
Age Factors↗
The A.M.A. explains peer review.
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Australia↗