title: A novel approach to quality improvement in a safety-net practice: concurrent peer review visits.
abstract: OBJECTIVE
  Concurrent peer review visits are structured office visits conducted by clinician peers of the primary care clinician that are specifically designed to reduce competing demands, clinical inertia, and bias. We assessed whether a single concurrent peer review visit reduced clinical inertia and improved control of hypertension, hyperlipidemia, and diabetes control among underserved patients.
  
  
  METHODS
  We conducted a randomized encouragement trial to evaluate concurrent peer review visits with a community health center. Seven hundred twenty-seven patients with hypertension, hyperlipidemia, and/or diabetes who were not at goal for systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and/or glycated hemoglobin (A1c) were randomly assigned to an invitation to participate in a concurrent peer review visit or to usual care. We compared change in these measures using mixed models and rates of therapeutic intensification during concurrent peer review visits with control visits.
  
  
  RESULTS
  One hundred seventy-one patients completed a concurrent peer review visit. SBP improved significantly (p < .01) more among those completing concurrent peer review visits than among those who failed to respond to a concurrent peer review invitation or those randomized to usual care. There were no differences seen for changes in LDL-C or A1c. Concurrent peer review visits were associated with statistically significant greater clinician intensification of blood pressure (p < .001), lipid (p < .001), and diabetes (p < .005) treatment than either for control visits for patients in either the nonresponse group or usual care group.
  
  
  CONCLUSIONS
  Concurrent peer review visits represent a promising strategy for improving blood pressure control and improving therapeutic intensification in community health centers.
authors.affiliation: Department of Family Medicine, University of Rochester, New York, USA. kevin_fiscella@urmc.rochester.edu
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
authors.forename: Ellen
authors.initials: E
authors.lastname: Volpe
authors.forename: Paul
authors.initials: P
authors.lastname: Winters
authors.forename: Melissa
authors.initials: M
authors.lastname: Brown
authors.forename: Amna
authors.initials: A
authors.lastname: Idris
authors.forename: Tricia
authors.initials: T
authors.lastname: Harren
mesh_terms: D000704:Analysis of Variance; D003151:Community Health Centers / Q000592:standards*; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000628:therapy*; D006973:Hypertension / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009518:New York; D010380:Peer Review; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement; D012042:Registries