Peer review of the quality of care. Reliability and sources of variability for outcome and process assessments

Peer assessments have traditionally been used to judge the quality of care, but a major drawback has been poor interrater reliability. The goal of this study by HIP Investigator Dr. Maureen Smith was to compare the interrater reliability for outcome and process assessments in a population of frail older adults and to identify systematic sources of variability that contribute to poor reliability.

Retrospective medical review of a total of 313 frail older adults from eight sites participating in a managed care program that integrates acute and long-term care for frail older adults was conducted. They found that peer assessments can play an important role in characterizing the quality of care for complex patients with multiple interrelated chronic conditions, but reliability can be poor and strategies to achieve adequate reliability for these assessments should be applied.