Physician-reviewers' perceptions and judgments about quality of care

Objective. Although Peer Review Organizations (PROs) and researchers rely o n physicians to assess quality of care, little is known about what physicia ns think about when they judge quality. We sought to identify features of i ndividual cases that are associated with physicians' judgments. Design. Using 1994 Medicare data, we selected hospitalizations for 1134 ben eficiaries in 42 acute care hospitals in California and Connecticut. The sa mple was enriched with 17 surgical and six medical complications identified using diagnosis and procedure codes. PRO physicians confirmed quality prob lems using a structured implicit chart review instrument and provided writt en open-ended comments about each case. We coded physicians' comments for f actors presumed to influence judgments about quality Results. In crude and adjusted comparisons, reviewers questioned quality mo re frequently in cases with serious or fatal outcomes, technical mishaps an d inadequate documentation. Among surgical (but not medical) patients, they were less likely to record poor quality among patients presenting with an acute illness. Conclusion. Factors other than the adequacy of key processes of care are as sociated with physician-reviewers' judgments about quality.