MAKING PEER-REVIEW STATISTICALLY ACCOUNTABLE

BACKGROUND: The peer review process used in most hospitals is largely anecdotal, leading to criticisms about the objectivity of the methods employed. METHODS: The results of 1,500 consecutive abdominal operatio ns performed by general surgeons working at three hospitals in a singl e community were reviewed. The outcome profile of each surgeon was com pared statistically to the cumulative profile of the surgical communit y with adjustments for physiologic status of the patient, difficulty o f the operation, and indications for surgery. RESULTS: A problem surge on was thus identified whose poor results were significantly different from the rest of the surgical community and could not be explained on the basis of unfavorable patient mix or complexity of the procedures undertaken. CONCLUSIONS: Statistical comparison of a surgeon's outcome profile with those of his colleagues working in the same practice env ironment is suggested as an approach to the task of peer review that m ight prove preferable to the usual retrospective review of problem cas es.