Peer Review versus Medical Record Review - What is the Difference

Peer Review versus Medical Record Review – What is the Difference

The standards for peer review are outlined in Chapter Five, Clinical Staffing and Chapter Ten, Quality Improvement/Assurance of the Health Resources and Services Administration (HRSA) Health Center Program Compliance Manual (Chapter Five, Chapter Ten). Chapter Five addresses the need to consider the results of peer review/performance improvement activities in the reappointment process for credentialing and privileging, while Chapter Ten addresses the need for the completion of quarterly Quality Improvement/Assurance assessments. Likewise, Chapter Ten discusses the need for Quality Improvement/Quality Assurance assessments to be conducted a minimum of quarterly by Physicians or other licensed health care professionals, such as nurse practitioners, registered nurses, or other qualified individuals.

Although HRSA provides minimal guidance regarding the topics of peer review and medical record review, there is a notable difference between the two.

Peer Review – Peer review must be completed between providers within the same specialty who are similarly credentialed and evaluates the quality and appropriateness of care being provided by the health center. Peer review criteria include, but are not limited to, the evaluation of the completeness and the accuracy of the patient assessment, the appropriateness of the treatment plan, including medications and referrals, and the effectiveness of the education being provided.
Medical Record Review – Medical record review can be completed by a licensed health care professional such as a Registered Nurse, evaluates compliance with the health center’s medical record documentation standards and determines whether a specific set of information has been appropriately documented in the medical record. This type of review is essentially an evaluation of whether or not the documentation was complete.

High performing health centers complete both peer review and medical record review and report results on a quarterly basis. Both reviews identify opportunities for improvement, facilitate the delivery of high-quality care and mitigate risk on the part of the health center. Resources for Peer Review and Medical Record Review can be found at ECRI (ECRI | Trusted Voice in Healthcare).

Community Health Centers (CHCs) serve all patients, regardless of race, ethnicity, gender or even ability to pay. As such, some CHCs receive special population funding which focuses on certain populations such as homeless^[1], Migrant and Seasonal Agricultural Workers (MSAW)^[1] and residents of public housing^[1]. If a health center receives this special funding OR additional funding that supplements their regular CHC funding (Section 330 e), it is a requirement that there is representation on the Board of Directors of these specific special populations. Chapter 20: Board Composition outlines those requirements. Receiving input from special population representatives provides a valuable resource in the successful oversight of the health center program in various key areas. For example:

Hours of Operation: A health center should have hours of operation that align to the most requested appointment times or in demand services. It’s important that health centers try to minimize access barriers as much as possible; ask patients if hours are a hindrance to receiving care. An example of minimizing access barriers would be to offer extended (evening) hours for MSAW as they work long hours and may not be able to take time off work during the day.
Accessible Locations: Health centers should review if the locations currently offered are accessible to all patients, including those patients identified as special populations. An evaluation of accessibility may mean traveling to the location of the patient instead of the patient coming to the health center. For example, patients identified as homeless may not have access to transportation; a health center may want to explore providing services at a local shelter, or analyzing whether getting a mobile unit would be financially feasible.

Input from special populations patients is extremely important. Without input from, e.g. homeless patients / those identified as homeless, or MSAW, a health center does not know if extended hours or changes in care delivery are needed.

Input from special populations can be completed through focus groups, patient satisfaction surveys or methods that are culturally and linguistically appropriate. Health centers should document this feedback along with discussion within the board of director’s meeting minutes.
^[1] https://bphc.hrsa.gov/programrequirements/compliancemanual/glossary.html

Core Modules

Healthcare Administration Operating System (HAOS)

Core Modules

Healthcare Administration Operating System (HAOS)

Peer Review versus Medical Record Review – What is the Difference

Have a question?

GET STARTED WITH COMPLIATRIC!