Do bad outcomes mean substandard care?

Article Abstract:

Previous research has shown that it is usually assumed that patients who suffer serious adverse effects from medical procedures must have received poor quality care. But the question arises, was the care really below standard quality, or were the judgments of its quality influenced by the outcomes? The study by Robert Caplan and colleagues in the April 17, 1991 issue of The Journal of the American Medical Association suggests that knowledge of an adverse outcome does influence judgment, making it more likely that the reviewer will judge the care as inappropriate or be more uncertain about the quality of care. Implicit reviews (based on personal opinion and experience) are imprecise, and different raters often arrive at different conclusions. Explicit (predetermined) criteria are difficult to establish. Both approaches have advantages and disadvantages, and can be used together. The methodological limitations of the study by Caplan and colleagues make it difficult to draw conclusions, especially since the reviewers knew that liability claims records were used for the cases. The Harvard Medical Practice Study used a more representative sample of hospital records, and found injury from substandard care was seven times more frequent than the number of events involved in liability claims. In spite of the limitations of the study by Caplan and others, it does add to the knowledge of the peer review process. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical malpractice, editorial, Peer review committees

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Can Physician Profiles Be Trusted?

Article Abstract:

More research is needed before physician profiles are widely used. Researchers have noticed widespread regional variations in medical care and have assumed doctors are to blame. Physician profiles are a way of rating doctors by comparing their practice to some standard. However, a 1999 study of primary care physicians found that physician profiles were not a reliable indicator of variations in the provision of care to diabetic patients. Only a fraction of the variation in this study was due to differences in the doctors' practices. Doctors and patients alike might become dissatisfied with these report cards.

Editorial

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Peer review of the quality of care: reliability and sources of variability for outcome and process assessments

Article Abstract:

The reliability of peer review when used to evaluate the care that patients receive needs to be improved. Researchers used the structured implicit review guidelines developed by RAND to evaluate the medical care received by 313 elderly patients with various conditions including arthritis, dementia, incontinence and hypertension. Evaluations were done by geriatricians and geriatric nurse practitioners and included measures of process as well as measures of outcome. Reliability of assessments between two or more raters was very poor on all measures of process but fair on several measures of outcome.

Peer review, Outcome and process assessment (Health Care), Outcome and process assessment (Medical care)

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