Hospital peer review and the National Practitioner Data Bank - Clinical privileges action reports

Context The National Practitioner Data Bank (NPDB) is believed to be an imp ortant source of information for peer review activities by the majority of those who use it. However, concern has been raised that hospitals may be un derreporting physicians with performance problems to the NPDB. Objective To examine variation in clinical privileges action reporting by h ospitals to the NPDB, changes in reporting over time, and the association o f hospital characteristics with reporting. Design Retrospective cohort study of privileges action reports to the NPDB between 1991 and 1995, linked with the 1992 and 1995 databases from the Ann ual Survey of Hospitals conducted by the American Hospital Association. Setting and Participants A total of 4743 short-term, nonfederal, general me dical/surgical hospitals throughout the United States that were continuousl y open between 1991-1995 and registered with the NPDB, Main Outcome Measures (1) Reporting of 1 or more privileges actions during the 5-year study period and (2) privileges action reporting rates (numbers of actions reported per 100 000 admissions). Results Study hospitals reported 3328 privileges actions between 1991 and 1 995; 34.2% reported 1 or more actions during the period. The range of privi leges action reporting rates for these hospitals was 0.40 to 52.27 per 100 000 admissions, with an overall rate of 2.36 per 100 000 admissions. The pr oportion of hospitals reporting an action decreased from 11.6% in 1991 to 1 0.0% in 1995 (P = .008), After adjustment for other factors, urban hospital s had significantly higher reporting than rural hospitals (adjusted odds ra tio [OR], 1.21 [95% confidence interval {CI}, 1.02-1.43]), while members of the Council of Teaching Hospitals of the Association of American Medical C olleges had significantly lower reporting than nonmembers (adjusted OR, 0.5 4 [95% CI, 0.40-0.73]). There were notable regional differences in reportin g, with the east south Central region having the lowest rate per 100 000 ad missions (1.49 [95% CI, 1.33-1.65]). Conclusions The results of this study indicate a low and declining level of hospital privileges action reporting to the NPDB. Several potential explan ations exist, 1 of which is that the information reported to the NPDB is in complete.