Using peer review and benchmarking to improve quality: A 4-step guide for ASC leaders

As regulatory changes place progressively tougher metrics on hospitals and ambulatory surgery centers, providers are held increasingly accountable for the quality and cost of care delivered.

Using data to track outcomes, derive insights and inform improvement efforts is vital to success in this stringent playing field. One such method of data collection, peer review, can be extremely beneficial in this regard, according to Laurie Deihs, RN, assistant director of education at the Accreditation Association for Ambulatory Health Care.

Peer review is the process by which providers evaluate the quality of their colleagues' work to ensure best practices are followed and the standards of care are met. It can incorporate a variety of metrics that impact clinical outcomes, cost, documentation and efficiency.

Peer review can serve a variety of functions, Ms. Deihs explained during a webinar hosted by Becker's ASC Review and AAAHC. "By creating peer review scorecards or dashboards, it can be used to quickly identify variation in individual performance, to show trends in organization-wide performance over time, to create internal benchmarks from which to build performance goals and to drive interventions and establish criteria for granting or denying privileges," she said.

Here are four steps for creating, implementing and using peer review in the ASC setting.

Step 1: Establish criteria for peer review

A structured peer review system includes explicit organization goals, adheres to regulatory requirements and provides a framework to measure clinical outcomes, according to Ms. Deihs. But what is perhaps most integral to the creation of criteria for peer review is the inclusion of those who will be reviewed in its development and application.

"Peer review is focused on licensed providers, so these are the individuals who should establish the criteria," said Ms. Deihs. "As we create meaningful improvement, we need to think about the kind of data that will provide a robust understanding of how the organization performs."

In addition to evaluating existing data — or what the ASC is already collecting — key performance indicators that will be compared to identify benchmarks should be added to the criteria. These might include complications, compliance, cost, timeliness, efficiency, documentation and utilization, according to Ms. Deihs.

Finally, the set of criteria should ensure the data collected will be valid, comparable and consistent.

Step 2: Collect and analyze the data

Once criteria are established, data should be collected by licensed peers in an ongoing manner and periodically evaluated to identify acceptable or unacceptable trends or occurrences that affect patient outcomes, according to Ms. Deihs.

"The evaluation may be on a quarterly basis or a monthly basis, but it's important to have a timeline established," said Ms. Deihs. "It may also be different for different criteria or metrics."

There are four ways to collect and interpret data.

1. The first is a retrospective review, which includes the use of a chart audit tool. According to Ms. Deihs, the EMR system in use at most hospitals and many ASCs makes it easy to filter data efficiently.

2. Data can also be used prospectively, or to predict future performance and plan strategy accordingly.

3. Providers can practice real-time collection, which is accomplished with a customized data collection tool to identify trends or issues and make changes right away.

4. Finally, providers can use observation. "There is a lot of data you can collect without a chart audit tool," said Ms. Deihs, "such as observing interactions with staff or important safety issues you could miss with the chart audit."

Step 3: Analyze results of peer review with internal and external benchmarking

Once the peer review data is collected, it is important to lay it out in a format that enables comparison between individuals within the organization, as well as individuals to the organization average, such as a scorecard or dashboard.

Scorecards or dashboards can also be used to compare the organization's performance to internal and external benchmarks.

Internal benchmarking is used to compare the organization's overall performance to that of individual performers, to identify the best and worst performer and any outliers. Internal benchmarking can also be used to identify trends in data and system-wide problems.

External benchmarks are industry standards that can be used to compare individual and organization-wide performance. These are helpful for setting performance goals.

Step 4: Develop quality improvement studies based on peer review data

"The organization implements data collection processes to ensure ongoing quality and to identify quality-related problems or concerns," said Ms. Deihs. After peer review data is collected and evaluated, findings are used to identify any unacceptable variation. 

If the organization's current performance meets or exceeds the performance goal, then no corrective action is needed for the organization or individual providers. However, if a physician is identified as a low performer, then provider-specific intervention may be warranted. Under such circumstances, awareness of low performance often motivates the physician to self correct. In all cases, the physician should be involved in designing a solution or intervention.

Results of peer review should also be used as part of the process when granting clinical privileges, according to Ms. Deihs. "If you have a consistently low performer, an action plan may need to be implemented.”

If the peer review reveals a system-wide problem — where most of the providers do not meet a performance goal — a quality improvement study is expected. Quality improvement studies involve a corrective action that addresses the source of the problems and a later remeasurement to see if the corrective action was effective and to document improvement.

To download the presentation as PDF, click here.

To view the webinar on YouTube, click here

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