[Assurance of process-quality in pulmonary practice by means of a peer-review system--a pilot project]

Quality assurance and quality-management have been well anchored in social legislation for years. Peer-reviews to assure process-quality and quality of outcomes have been conducted repeatedly in centres for pulmonary medicine, facilities for pulmonary rehabilitation as well as centres for sleep-medicine. By means of a pilot study we wanted to investigate if assurance of process-quality is feasible and if a peer review system turns out to be a suitable method in pulmonary practice. Medical reports and/or diagnostic protocols of the investigational procedures such as pulmonary function tests, allergy-tests, induction test of bronchial hyperresponsiveness et cetera were randomly collected from nine patients with bronchial asthma or COPD in each of the 44 participating pulmonary practices and forwarded to three peer-reviewers respectively. 396 selected patient-datasets resulted in 1188 reviews. Peer review was conducted by means of a specially developed checklist of markers of process-quality accompanied by an explanatory manual. Measures of quality were determined for every pulmonary practice and a report of results was generated. The health economical efficacy of the therapy and the diagnostic process as well as an assessment of the overall process was evaluated by means of a visual analogue scale. No deficiencies could be detected in clearly more than half of the assessments. Major deficiencies or an unacceptable result in different items could be detected in every sixth assessment. For every item a graphic ranking in terms of benchmarking was generated for each individual report. Since peers were reviewers and subjects of review at the same time, they can now clearly improve and assure their diagnostic and therapeutic process-quality in patients with bronchial asthma and COPD by means of the experience they gained during the review process, as well as by the assessment they received. We were able to demonstrate that a peer-review-system is appropriate to assure process-quality in pulmonary practice and that it is feasible to achieve a continuous assurance and improvement of quality in the long run.