A Novel Approach to Quality Improvement in a Safety-Net Practice

Concurrent peer review visits are patient care visits by peers of a primary care provider, designed to improve patient care. A study of the effects of such visits on control of hypertension, hyperlipidemia and diabetes and treatment intensification in a community health center found that the visits improved outcomes for hypertension patients and increased treatment intensification for all three conditions.

The authors randomly invited 727 patients with hypertension, hyperlipidemia and/or diabetes to participate in either a concurrent peer review visit or their regular care. They compared outcomes and rates of treatment intensification among patients who attended the concurrent peer review visit, invited patients who failed to respond, and regular care patients.

Hypertension patients’ systolic blood pressure improved more for those participating in concurrent peer review visits than for patients in nonresponse or control groups. There were no differences in outcomes among the groups for hyperlipidemia or diabetes patients. Concurrent peer review visits also led to greater treatment intensification for all three conditions.

Concurrent peer review visits may improve care for hypertension patients, and improve treatment intensification in community health centers. Limitations include having carried out the study among a cohesive group of clinicians who were dedicated to quality improvement and possible selection bias.