title: Practice patterns for peer review in radiation oncology.
abstract: OBJECTIVE
  Physician peer review seeks to improve the quality of care through the evaluation of physician performance, specifically medical decision making and technical expertise. To establish current peer review practice patterns, evaluate interest in recommendations for peer review, and establish a framework for future recommendations, the American Society for Radiation Oncology (ASTRO) surveyed its physician members.
  
  
  METHODS
  A radiation oncology-specific peer review survey instrument was developed, formally tested, and found to meet established levels of reliability and validity. The final instrument was delivered using a web-based survey platform including reminders. All ASTRO physician-members and members-in-training worldwide were invited by email to participate.
  
  
  RESULTS
  A total of 5674 physicians were contacted starting in January 2013. A total of 572 physicians participated (10%) yielding a ±4% margin of error. Those responding were split evenly between academic providers and private practice and others. The median time since training=16 years, median number of new patients per year=215, and median practice size=6 physicians; 83% of respondents were involved in peer review and 75% were comfortable with their program. Of those involved, 65% report doing some review before radiation begins. Of patients treated by these physicians, 56% are reviewed before treatment. Peer review elements reviewed include overall treatment strategy (86%), dose and fractionation (89%), contouring (59%), and isodose or dose-volume histogram (75%). Ninety percent of physicians have changed radiation plans because of peer review. These providers make changes in 7%-10% of cases. Seventy-four percent of physicians agree that ASTRO should make formal peer review recommendations, with 7% in opposition.
  
  
  CONCLUSIONS
  This survey suggests that peer review in radiation oncology is common and leads to changes in management in a meaningful fraction of cases. There is much variation in the manner of conducting, and reported utility of, peer review. The majority of ASTRO physician members support formal recommendations and guidance on peer review.
authors.affiliation: Joint Radiation Oncology Center, Travis Air Force Base, California. Electronic address: davidjhoopes@gmail.com.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hoopes
authors.affiliation: Department of Radiation Oncology, Indiana University, Indianapolis, Indiana.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Johnstone
authors.affiliation: Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Ohio.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Chapin
authors.affiliation: Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Ohio.
authors.forename: Christine M Schubert
authors.initials: CM
authors.lastname: Kabban
authors.affiliation: Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina.
authors.forename: W Robert
authors.initials: WR
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology and Division of Population Sciences, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Aileen B
authors.initials: AB
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Benedick A
authors.initials: BA
authors.lastname: Fraass
authors.affiliation: Department of Radiation Oncology, Walter Reed Bethesda National Military Medical, Bethesda, Maryland.
authors.forename: William J K
authors.initials: WJ
authors.lastname: Skinner
authors.affiliation: Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Marks
mesh_terms: D019538:Health Care Surveys; D006801:Humans; D010380:Peer Review / Q000379:methods*; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D018787:Radiation Oncology / Q000592:standards*