RAND Health has developed tools to enable health care organizations to measure the quality of inpatient or outpatient clinical care practically and reliably.
Peer review relies on quality judgments by expert professionals to evaluate quality of care based on review of the medical record. A structured implicit review is more reliable because the key aspects of care and data sources to be reviewed are specified in advance.
We developed structured implicit reviews of the quality of inpatient and outpatient clinical care for diverse medical and surgical conditions.
We used the medical literature and the clinical judgment of physicians to conceptualize the process of patient care and to identify standards against which the process of care could be evaluated.
We asked panels of national physician experts to review both our models and the standards.
We rigorously tested the review forms in large studies, and found them to be reliable and valid.
Quality of inpatient care is assessed in term of the process of physician and nursing care, the appropriateness of hospital services, patient prognosis, treatability of the patient's condition, preventability of death when it occurred, and quality of the outcome. The form also asks the reviewer to rate overall quality of care delivered during the hospitalization. A separate nursing peer review form is also available to increase the reliability with which inpatient nursing quality can be evaluated.
Quality of outpatient care is assessed in five areas: prevention and screening; minor illnesses and chronic illnesses; acute illness episodes; communication, education, and access to care; and overall quality.
The implicit review forms for both inpatient and outpatient care and the instruction manuals for using them are available directly from RAND. The relevant documents are listed below.
Rubenstein LV, Kahn KL, Reinisch EJ, Sherwood MJ, Rogers WH, Kamberg C, Draper D, Brook RH. Changes in Quality of Care for the Five Diseases Measured by Implicit Review, 1981 to 1986, Journal of the American Medical Association, Vol. 264, No. 11, 1990, pp. 1974-1979.
Rubin JR, Rogers WH, Kahn KL, Rubenstein LV, Brook RH. Watching the Doctor-Watchers: How Well Do Peer Review Organization Methods Detect Hospital Care Quality Problems, Journal of the American Medical Association, Vol. 267, No. 17, 1992, pp. 2349-2354.