{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T13:25:44Z","timestamp":1765545944647,"version":"3.44.0"},"reference-count":48,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2014,9,7]]},"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Many healthcare organisations (HCOs) use peer review to evaluate clinical performance, but it is unclear whether these data provide useful insights for assessing the sharp end of patient safety.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To describe outcomes of peer review within the Department of Veterans Affairs (VA) healthcare system and identify opportunities to leverage peer review data for measurement and improvement of safety.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>We partnered with the VA's Risk Management Program Office to perform descriptive analyses of aggregated peer review data collected from 135 VA facilities between October 2011 and September 2012. We determined the frequency of screening factors used to initiate peer review and processes contributing to substandard care. We also evaluated peer review data for diagnosis-related performance concerns, an emerging area of interest in the patient safety field.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>During the study period, 23\u2005287 cases were peer reviewed; 15\u2005739 (68%) were sent to local peer review committees for final outcome determination after an initial review and 2320 cases were ultimately designated as substandard care (mean 17 cases\/facility). In 20% of cases, the screening source was unspecified. The most common process contributing to substandard care was \u2018timing and appropriateness of treatment\u2019. Approximately 16% of committee reviewed cases had diagnosis-related performance concerns, which were estimated to occur in approximately 0.5% of total hospital admissions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Peer review may be a useful tool for HCOs to assess their sharp end clinical performance, particularly safety events related to diagnostic and treatment errors. To address these emerging and largely preventable events, HCOs could consider revamping their existing peer review programmes to enable self-assessment, feedback and improvement.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjqs-2014-003239","type":"journal-article","created":{"date-parts":[[2014,9,27]],"date-time":"2014-09-27T03:02:23Z","timestamp":1411786943000},"page":"1023-1030","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Exploring new avenues to assess the sharp end of patient safety: an analysis of nationally aggregated peer review data"],"prefix":"10.1136","volume":"23","author":[{"given":"Derek W","family":"Meeks","sequence":"first","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA"},{"name":"Department of Medicine, Section of General Internal Medicine, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley N D","family":"Meyer","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA"},{"name":"Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Rose","sequence":"additional","affiliation":[{"name":"Risk Management Program, Office of Quality, Safety, and Value, Department of Veterans Affairs, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuri N","family":"Walker","sequence":"additional","affiliation":[{"name":"Risk Management Program, Office of Quality, Safety, and Value, Department of Veterans Affairs, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hardeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA"},{"name":"Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,9,26]]},"reference":[{"key":"2025090412351778000_23.12.1023.1","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2007.023655"},{"key":"2025090412351778000_23.12.1023.2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000157096.95223.D7"},{"key":"2025090412351778000_23.12.1023.3","doi-asserted-by":"publisher","DOI":"10.1177\/1062860609352438"},{"key":"2025090412351778000_23.12.1023.4","first-page":"399","article-title":"The Elephant of Patient Safety: What You See Depends on How You Look","volume":"36","author":"Shojania","year":"2010","journal-title":"Jt Comm J Qual Patient Saf"},{"key":"2025090412351778000_23.12.1023.5","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2011.0190"},{"key":"2025090412351778000_23.12.1023.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2012-000803"},{"key":"2025090412351778000_23.12.1023.7","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2003.20147.x"},{"key":"2025090412351778000_23.12.1023.8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.249"},{"key":"2025090412351778000_23.12.1023.9","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2013-001935"},{"key":"2025090412351778000_23.12.1023.10","doi-asserted-by":"crossref","unstructured":"Giardina TD, King BJ, Ignaczak AP, et al. Root cause analysis reports help identify common factors in delayed diagnosis and treatment of outpatients. Health Aff (Millwood) 2013;32:1368\u201375.","DOI":"10.1377\/hlthaff.2013.0130"},{"key":"2025090412351778000_23.12.1023.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2011-000304"},{"key":"2025090412351778000_23.12.1023.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2012-001624"},{"key":"2025090412351778000_23.12.1023.13","doi-asserted-by":"crossref","unstructured":"Cook RI , Render ML . Operating at the sharp end: the complexity of human error. In: Bogner MS , ed. Human error in medicine. Lawrence Erlbaum Associates, Inc, 1994:255\u2013310.","DOI":"10.1201\/9780203751725-13"},{"key":"2025090412351778000_23.12.1023.14","doi-asserted-by":"publisher","DOI":"10.1177\/1062860611421981"},{"key":"2025090412351778000_23.12.1023.15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197306212882504"},{"key":"2025090412351778000_23.12.1023.16","unstructured":"Seago JA , Benroth R , McDougall MHAB , et al . Comprehensive study of peer review in California: final report. San Francisco: Lumetra, 2008."},{"key":"2025090412351778000_23.12.1023.17","unstructured":"Government Accountability Office (GAO). VA health care: improvements needed in processes used to address providers\u2019 actions that contribute to adverse events. 12-3-2014. Government Accountability Office. 1-8-2014."},{"key":"2025090412351778000_23.12.1023.18","unstructured":"Massachusetts Medical Society. Model principles of incident-based peer review for health care facilities. Massachusetts Medical Society, 2005."},{"key":"2025090412351778000_23.12.1023.19","unstructured":"Veterans Health Administration. Peer review for quality management . Washington, DC: VHA Directive 2010-025, 2013."},{"key":"2025090412351778000_23.12.1023.20","doi-asserted-by":"publisher","DOI":"10.1177\/1062860610368427"},{"key":"2025090412351778000_23.12.1023.21","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.3.302"},{"key":"2025090412351778000_23.12.1023.22","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1001\/jamainternmed.2013.2777","article-title":"Types and origins of diagnostic errors in primary care settings","volume":"176","author":"Singh","year":"2013","journal-title":"JAMA Intern Med"},{"key":"2025090412351778000_23.12.1023.23","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198703053161006"},{"key":"2025090412351778000_23.12.1023.24","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(01)00679-1"},{"key":"2025090412351778000_23.12.1023.25","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.4.381"},{"key":"2025090412351778000_23.12.1023.26","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.328.7450.1240"},{"key":"2025090412351778000_23.12.1023.27","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03500130069034"},{"key":"2025090412351778000_23.12.1023.28","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.1999.10148.x"},{"key":"2025090412351778000_23.12.1023.29","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1992.03480070074034"},{"key":"2025090412351778000_23.12.1023.30","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.4.349"},{"key":"2025090412351778000_23.12.1023.31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2005.00630.x"},{"key":"2025090412351778000_23.12.1023.32","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.423"},{"key":"2025090412351778000_23.12.1023.33","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.6382"},{"key":"2025090412351778000_23.12.1023.34","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1002\/jhrm.21123","article-title":"A red-flag-based approach to risk management of EHR-related safety concerns","volume":"33","author":"Sittig","year":"2013","journal-title":"J Healthc Risk Manag"},{"key":"2025090412351778000_23.12.1023.35","unstructured":"Office of Inspector General (OIG). Adverse events in hospitals: national incidence among medicare beneficiaries. OEI-06-09-00090. 2010. Department of Health and Human Services. 8-8-2014."},{"key":"2025090412351778000_23.12.1023.36","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2010.146"},{"key":"2025090412351778000_23.12.1023.37","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2011-000149"},{"key":"2025090412351778000_23.12.1023.38","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2012-001539"},{"key":"2025090412351778000_23.12.1023.39","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-145-7-200610030-00006"},{"key":"2025090412351778000_23.12.1023.40","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2013-002627"},{"key":"2025090412351778000_23.12.1023.41","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2012.01.110174"},{"key":"2025090412351778000_23.12.1023.42","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.333"},{"key":"2025090412351778000_23.12.1023.43","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2009.01328.x"},{"key":"2025090412351778000_23.12.1023.44","doi-asserted-by":"publisher","DOI":"10.1001\/2012.jama.11913"},{"key":"2025090412351778000_23.12.1023.45","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1035"},{"key":"2025090412351778000_23.12.1023.46","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-014-2890-1"},{"key":"2025090412351778000_23.12.1023.47","doi-asserted-by":"crossref","unstructured":"Meyer AD, Payne VL, Meeks DW, et al. Physicians diagnostic accuracy, confidence, and resource requests: A vignette study. JAMA Internal Medicine 2013;173:1952\u201358.","DOI":"10.1001\/jamainternmed.2013.10081"},{"key":"2025090412351778000_23.12.1023.48","doi-asserted-by":"crossref","unstructured":"Marshall M , Pagel C , French C , et al . Moving improvement research closer to practice: the Researcher-in-Residence model. BMJ Qual Saf 2014;23:801\u20135.","DOI":"10.1136\/bmjqs-2013-002779"}],"container-title":["BMJ Quality &amp; Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjqs-2014-003239","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T19:35:26Z","timestamp":1757014526000},"score":1,"resource":{"primary":{"URL":"https:\/\/qualitysafety.bmj.com\/lookup\/doi\/10.1136\/bmjqs-2014-003239"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,9,26]]},"references-count":48,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2014,11,14]]},"published-print":{"date-parts":[[2014,12]]}},"alternative-id":["10.1136\/bmjqs-2014-003239"],"URL":"https:\/\/doi.org\/10.1136\/bmjqs-2014-003239","relation":{},"ISSN":["2044-5415","2044-5423"],"issn-type":[{"type":"print","value":"2044-5415"},{"type":"electronic","value":"2044-5423"}],"subject":[],"published":{"date-parts":[[2014,9,26]]}}}