subject: Peer Review Organizations [print this page] A peer review organization can assist any group in learning more about improvement methodologies that can be applied. These recommendations for improvement are made as a results of the conclusions from the discovery as applied in the medical records review process. The primary areas of review are meant to insure the quality of health care services, increase awareness of organizational goals and methods to achieve them and to learn more about the standards of practice as they are applied across a large section of patient populations in varying environments and practice settings.
The analysis by a peer review organization is achieved by a combination of quantitative statistical methods and the application of expert methods in clinical settings. These methods apply equally as well irrespective of whether the organization is a government agency, a HMO, a managed health care facility, a PPO, a self-insured program. Regardless of the type of health care organization, a peer review organization can provide a perspective on the medical record review that is not able to be achieved in house because there is an objective analysis made by trained physicians, nurses, epidemiologists, data experts, system analysts, and organizational health care administration experts. Because there is no influence of side agendas in that the experts are free to give their opinions on specific cases without any fear of departmental troubles or excess management scrutiny for noticing and admitting potential errors, the analysis can be very illuminating.
Because the medical records analysis is done systematically without individual patient identification, there is no excess liability created by the independent peer review organization when notification is taken of mistakes made and where improvement may be achieved.
A good peer review organization is a full service group that is capable of performing a review at a high level of quality where the review procedures can be customized to meet the needs of the client to provide the best results for the health care organization and for the community as a whole.
Peer review organizations are judged on their ability to provide an expert opinion in the time frame that is allocated for the study. They need to have the staffing with the credentials that are qualified to make the analysis and they need to understand the case specifics as well as the goals of the organization as a whole.
