Medical Peer Review - History

History

Medical audit, which remains the predominant mode of peer review in Europe, is a focused study of the process and/or outcomes of care for a specified patient cohort using pre-defined criteria, focused on a diagnosis, procedure or clinical situation. This audit process was revised by changes to The Joint Commission standards were revised in 1979, dispensing with the audit requirement and calling for an organized system of Quality Assurance (QA). Thus the objective of a medical peer review committee became, to investigate the medical care rendered in order to determine whether accepted standards of care have been met. Contemporaneous with this change, hospitals and physicians adopted generic screening to improve quality of care, despite warnings from the developers of these screens that they were not validated for this purpose, having originally been developed to evaluate no-fault malpractice insurance plans.

The focus on the question of whether the standard of care had been met persisted despite many criticisms, but is increasingly recognized to be outdated, replaced over the past decade by Quality Improvement (QI) principles.