winter 2012

p r a c t i c e   m a n a g e m e n t
From Peer to Peer

 

Offsite chart review good predictor of onsite review results


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Atlantic Provinces Medical Peer Review's Offsite Assessment utilizes both patient charts and demographic factors in a process which is less time-consuming for the physician involved and less costly for us.

By Dr. Jean-Marie Auffrey

Atlantic Provinces Medical Peer Review (APMPR) assessors over the years have reported that they can usually tell after examining the first few patient charts whether the physician being reviewed is providing good patient care and appropriately documenting it.

There are also demographic factors which can point toward success or failure with peer review including physician age, hours invested in CME, the number of patients seen each week, and whether or not the physician works alone or has the benefit of “corridor consults” with colleagues.

APMPR’s Offsite Assessment utilizes both patient charts and demographic factors in a process which is less time-consuming for the physician involved and less costly for us. It has been a part of our process since 2002, after a year-long pilot project confirmed our belief that demographics and a limited chart review were valid offsite predictors of onsite review results. Each year roughly 40 per cent of APMPR assessments are done through the offsite process.

Offsite assessment involves having the physician being reviewed complete a physician questionnaire, write a brief autobiography, and send five patient charts representing approximately one year of patient care to our office. The questionnaire provides a snapshot of the physician’s background, experience, CME, scope of practice and number of patients seen weekly.We are often asked why we request a short autobiography written by the physician. It’s not our intention to pry into one’s personal life, but it is important to us to know that you have one! The physician who reports that he or she is in a solo practice seeing a high volume of patients weekly, has no outside interests, and “hasn’t had time for a vacation” may be at risk for physician burnout, and an onsite review is probably a better approach.

A peer assessor considers the patient charts sent for offsite assessment, and these are specific to the type of practice being reviewed. For example, family physicians are requested to send one chart each from type II diabetes Mellitus and chronic pain, and three of the following four: heart failure, COPD, hypertension, or dyslipidemia - a total of five charts only, five different disease entities. Obstetricians/gynaecologists are asked to send one chart each from abnormal uterine bleeding, uterine prolapse, dysmenorrhea, spontaneous miscarriage and vaginal bleeding, again a total of five charts from five disease entities. In addition to family medicine and obstetrics/gynaecology, APMPR also uses offsite assessment in the review of some physicians practising in pediatrics, internal medicine or cardiology.

Offsite review is not designed to completely replace onsite review and, in some cases, it is not an option. Hospital-based practices, where the charts do not belong to the individual physician, do not lend themselves to offsite review. And those physicians who have not done well on previous peer assessments are not likely to be offered offsite review until an onsite review has indicated that all is well in the practice. It is also important to note that we recognize the limitations of a review which only examines a few charts. If the assessor doing the chart review has the slightest concern that there may be deficiencies in the practice, an onsite review is scheduled for the next assessment year.

Dr. Jean-Marie Auffrey is Board chair and medical director with the Atlantic Provinces Medical Peer Review program.

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