The Colorado Medicare study: Perspective of the peer review committee.

In 1977, the Social Security Administration sponsored a study to determine whether including psychologists as independent providers and increasing the dollar limit of Medicare's mental health benefits would have an impact on the availability of mental health care to Medicare recipients, the quality of care provided, and the cost and utilization of the program. The present study discusses peer review issues that emerged from the study: (1) the peer review criteria for quality of care provided, (2) the range of covered services and covered diagnoses under Medicare, (3) the unique patient population aspects, (4) patient participation in the treatment plans and outcome forms used for peer review, (5) the issue of confidentiality of the peer review forms, (6) and findings regarding medical consultation on cases treated by psychologists. The review committee concluded that within the limits of the study, the review system was successful and the quality of services delivered was high. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A model system of peer review.

Discusses issues involved in the establishment of an effective system of peer review of mental health services: selection of reviewers and cases for review, development of criteria for review, documentation, management of the review process, and management of information (including confidentiality). Decisions regarding most of these issues may be made at the local agency level. A national system of peer review that would facilitate the development of local review systems and provide the support necessary to ensure the acceptance of quality assurance efforts as routine professional activities is presented. The system would function on 4 levels. The 1st 2 levels would function locally and involve selection by trained nonpsychologists of cases for review and review of those cases by a committee of professionals. At the 3rd level, a peer review consortium would review special cases; and at the 4th level, a group supported by the American Psychological Association would assist local agencies in the development of peer review systems and would serve other policymaking functions. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Professional Standards Review Committee: Form and function.

Presents a history of Professional Standards Review Committees (PSRCs) and discusses their form and function. The impetus for professional standards reviews grew out of 3rd-party reimbursement for psychological services. The first guidelines for operations of PSRCs were issued in 1968. In 1975, a PSRC procedures manual presenting guidelines for the operation of state PSRCs was developed by the American Psychological Association Committee on Professional Standards Review. State PSRCs were charged with reviewing care to determine whether practice was "usual, customary, or reasonable." However, most PSRCs have reviewed only a small number of cases. The majority of cases reviewed have dealt with conflict over fees or 3rd-party concerns about overutilization. PSRC proceedings have been confidential and typically nonadversarial. A major purpose of PSRCs is to educate providers, consumers, and 3rd-party payers about good professional practice. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological and psychiatric peer review at CHAMPUS.

Considers professional reviews of psychological and psychiatric services, which have been conducted by 3rd-party payers for a number of years by various arrangements. It was not until 1979, however, that a major 3rd-party payer, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), developed a comprehensive operational peer review activity. This action was stirred by the need for the program to account for quality of services provided its beneficiaries and to ensure cost-beneficial care. The development of collaboration between the program and major professional organizations (American Psychological Association and American Psychiatric Association) is traced, as are the successes and problems encountered thus far. It is concluded that peer review should be a consistent aspect of future 3rd-party determinations. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Invited peer review: The AABT experience.

In response to the growing need to provide the independent evaluation and examination of treatment programs, the Association for Advancement of Behavioral Therapy (AABT) formed the Professional Consultation and Peer Review Committee. The present study describes the peer review process in a hierarchical manner, beginning with the least demanding type of review or consultation and progressing to a full-scale evaluation. In the past 2 yrs, this committee has developed 6 types of review services that it offers free of charge to interested consumers and behavior therapists: individual case consultation between therapists, a compilation of guidelines for behavioral treatment programs, review of written materials of particular programs, on-site review of noncontroversial and controversial programs, and professional assistance in litigation involving determination of appropriate treatment. In all cases the committee promotes reliance on the empirical literature as the justification for treatment decisions and program operation. It is concluded that the review services are designed to protect individual clients and competent therapists and to assist in assuring appropriate treatment. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Criteria for insurance review of psychological services.

The American Psychological Association has contracted to develop a national peer review capability for the review of outpatient psychological services. The system that has been developed and the criteria that will be utilized for the purpose of selecting cases for review are described. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research on quality assurance.

Psychology has not been sufficiently attentive to the need to demonstrate the effectiveness of mechanisms intended to ensure the quality of psychological services. The mechanisms are numerous, but peer review has been among the most prominent. Research is needed to justify reliance on peer review. Specifically, peer review must be demonstrated to be reliable in the decisions it produces, and those decisions must be valid in furthering more nearly optimal treatment outcomes. A peer review system must also be credible in the profession. Research can help to improve criteria for peer review, improve the processes by which it operates, and determine its effects on treatment outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Omentoplasty in the management of filarial lymphoedema

OBJECTIVE: Peer review is an important part of the publication of scientific results. We analysed the peer review process of abstracts submitted to the European Association for the Study of the Liver (EASL) congress in Copenhagen in 1995. DESIGN: Comparative study. All abstracts were reviewed by all six members of the EASL scientific committee. Furthermore, each abstract was evaluated by three to six experts within 17 specific study fields, appointed by the scientific committee. All abstracts received a score on a scale from 1 to 5, one being the best. For each abstract the average was calculated for the scores of the committee members and the expert reviewers separately. MAIN OUTCOME MEASURE: Abstract score. RESULTS: There was a significant difference in the scores between the committee members, who scored 3.31 on average, and the expert reviewers, who scored 3.02 on average. Within most of the study fields the tendency was that the expert reviewers gave the highest scores. Moreover, there was a significant variation in the estimates among the individual reviewers as well as between the 2 groups of reviewers. Only 25% of the abstracts that received the best scores by the expert reviewers were classified in the same way by the committee members. The predictive value of a positive evaluation by the committee members was 0.6, the predictive value of a negative evaluation was 0.90. CONCLUSIONS: There was a considerable variation in the peer review process for abstracts submitted to the 1995 EASL congress depending on selection of reviewers. Various types of peer review strategies should be tested and evaluated to secure the highest possible scientific quality of published research results.     

Peer review: A private practice model.

The Peninsula Hospital Community Mental Health Center in California, in collaboration with community private practitioners, instituted a peer review plan to meet fiscal problems while permitting quality patient care. The present paper describes the plan and the functioning of the peer review committee. There were initial objections to the plan by most of the private practicing professionals concerned. The attitudes of 76 practitioners, as well as those of 19 peer reviewers, were assessed in questionnaires 3 yrs after the start of the peer review plan. Results of the questionnaires are discussed. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Education and peer review.

The success of a peer review system to assure quality of psychological services depends on its acceptance by psychologists, consumers, and 3rd-party agents. Educational efforts aimed at these 3 target groups are important in facilitating that acceptance. The present study outlines components of the educational program adopted by the developers of the American Psychological Association/CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) peer review system. Components that, although not part of the CHAMPUS system, should be included in an ideal educational effort are also outlined. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric peer review: a working model

The author describes a system for psychiatric peer review developed by a peer review committee in a general hospital. At the heart of the system is a form called the peer review check sheet, which requires the physician to specify diagnosis, reasons for hospitalization, and major symptom complexes, as well as laboratory work and treatment and discharge plans. Minimal criteria have been established to verify the diagnoses and to justify the need for hospitalization. Each month the check sheets are removed from the charts of patients who have been discharged and sent to committee members for evaluation. Those that are incomplete or unsatisfactory signal the need to examine the patient's chart.     

Report by the… ; purposes, standards, and procedures.

"The American Board for Psychological Services was incorporated to accomplish one fundamental purpose: to serve the public interests by providing a directory of agencies judged to be capable of providing competent psychological services to the public." Means by which ABPS intends to achieve its functions, the definition of "psychological service," criteria for evaluation of psychological services, evaluation procedures, means of appeal from ABPS judgments, reevaluations, and current fees and charges of ABPS, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving the peer-review process for grant applications: Reliability, validity, bias, and generalizability.

Peer review is a gatekeeper, the final arbiter of what is valued in academia, but it has been criticized in relation to traditional psychological research criteria of reliability, validity, generalizability, and potential biases. Despite a considerable literature, there is surprisingly little sound peer-review research examining these criteria or strategies for improving the process. This article summarizes the authors' research program with the Australian Research Council, which receives thousands of grant proposals from the social science, humanities, and science disciplines and reviews by assessors from all over the world. Using multilevel cross-classified models, the authors critically evaluated peer reviews of grant applications and potential biases associated with applicants, assessors, and their interaction (e.g., age, gender, university, academic rank, research team composition, nationality, experience). Peer reviews lacked reliability, but the only major systematic bias found involved the inflated, unreliable, and invalid ratings of assessors nominated by the applicants themselves. The authors propose a new approach, the reader system, which they evaluated with psychology and education grant proposals and found to be substantially more reliable and strategically advantageous than traditional peer reviews of grant applications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response rate accuracy in oncology trials: reasons for interobserver variability. Groupe Fran?ais d'Immunothérapie of the Fédération Nationale des Centres de Lutte Contre le Cancer

PURPOSE: We evaluated the impact of an evaluation committee (EC) on patients' overall response status in a large multicenter trial in oncology. We identified reasons for disagreements between investigators and the EC. MATERIALS AND METHODS: The Cancer Renal Cytokine (CRECY) study was a French multicenter trial that tested cytokine therapy in 489 patients with metastatic renal cell carcinoma. Objective response (OR) evaluation included medical imaging and was studied according to international guidelines. A blinded peer review of all responders and litigious cases was performed by an EC. RESULTS: Major disagreements occurred in 40% and minor disagreements in 10.5% of the reviewed files. The number of significant tumor responses was reduced by 23.2% after review by the EC. Reasons for disagreements included errors in tumor measurements, errors in selection of measurable targets, intercurrent diseases, and radiologic technical problems. These reasons for disagreements are analyzed and discussed. CONCLUSION: We conclude that all therapeutic trial results should be reviewed by peer analysis of all presumed responders by an EC. International guidelines for response evaluation should be updated by including more reliable methods of measurements and definition of minimal imaging procedures.     

Casebook for Providers of Psychological Services.

The Committee on Professional Standards (COPS) of the Board of Professional Affairs (BPA) is the APA governance committee charged with the responsibility for development and interpretation of the Association's quality assurance policy. In its initial charge to COPS, BPA asked the committee to develop a "casebook for providers of psychological services." The goal of the casebook would be the implementation of the Specialty Guidelines for the Delivery of Services by Clinical (Counseling, Industrial/Organizational, School) Psychologists (approved by Council in January 1980). The focus of the cases would be quality assurance problems that came to the attention of COPS directly or through other governance bodies such as the Committee on Academic Freedom and Conditions of Employment or the Committee on Scientific and Professional Ethics and Conduct, COPS would be responsible for developing three or four cases per year, with these cases appearing in the June archival issue of the American Psychologist. This report contains the first three cases, developed by COPS during its October 1980 meeting and approved for publication by the Board of Professional Affairs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

APA/CHAMPUS peer review project: Implications for research and practice.

Describes the history of the American Psychological Association (APA) peer review of psychological services provided under the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), the operational details of the system, and some of the criticisms of the project. Research is summarized that examined the characteristics of peer reviewers, the effects of the theoretical orientation of the reviewer, and the effects of documented treatment progress. Implications for care providers, patients, and the profession are discussed. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A look backward: The peer review program of the American Psychological Association.

The American Psychological Association (APA) contracted with a major insurance company to implement an experimental peer review program between 1982 and 1986. One hundred fifty mental health treatment reports (MHTRs) and 72 corresponding peer reviews were analyzed to determine criteria for review and review outcome. Longer, more intensive treatments were reviewed more often, and shorter treatments were reviewed more positively. MHTRs were less often reviewed if they estimated treatment length, stated appropriate plans and goals, responded to need for medication, and were clearly written. MHTRs were positively reviewed for the same reasons and for mentioning measurable functional impairment and how patients used treatment support and intervention. Relation of findings to past research and APA peer review as a whole are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)