title: Assessing the Quality of a Radiation Oncology Case-Based, Peer-Review Program in an Integrated Academic and Community Cancer Center Network.
abstract: OBJECTIVE
  Academic centers increasingly find a need to define a comprehensive peer-review program that can translate high-quality radiation therapy (RT) to community network sites. In this study, we describe the initial results of a quarterly quality audit program that aims to improve RT peer-review and provider educational processes across community sites.
  
  
  METHODS
  An electronic tool was used by community-based certified member (CM) sites to enter clinical treatment information about patients undergoing peer review. At least 10% of the patient load for each CM physician was selected for audit on a quarterly basis by expert academic faculty. Quality metrics included the review of the management plan, technical plan, and other indicators. RT was scored as being concordant or nonconcordant with institutional guidelines, national standards, or expert judgment.
  
  
  RESULTS
  A total of 719 patients were entered into the peer-review database by the first four CM sites. Of 14% of patients audited, 17% (18 of 104) were deemed nonconcordant. Nonconcordance rates were lowest in prevalent disease sites, such as breast (16%), colorectal (14%), and lung (12%), whereas rates were highest in lymphoma (50%), brain (44%), and gynecology (27%). Deficiencies included incomplete staging work-up, incorrect target and normal tissue delineation, and nonadherence to accepted dose-volume constraints.
  
  
  CONCLUSIONS
  Given the high rate of nonconcordance, we recommend prospective, pre-RT peer review of all patients, and, in particular, expert review of patients that are from low-volume or complex disease sites. An integrated approach to peer review holds a promise of improving the quality, safety, and value of cancer therapy in the community setting.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Nikhil G
authors.initials: NG
authors.lastname: Thaker
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Laurie
authors.initials: L
authors.lastname: Sturdevant
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Anuja
authors.initials: A
authors.lastname: Jhingran
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Marc E
authors.initials: ME
authors.lastname: Delclos
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Gary B
authors.initials: GB
authors.lastname: Gunn
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Mary Frances
authors.initials: MF
authors.lastname: McAleer
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Welela
authors.initials: W
authors.lastname: Tereffe
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Seungtaek L
authors.initials: SL
authors.lastname: Choi
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: William J
authors.initials: WJ
authors.lastname: Simeone
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Wendi
authors.initials: W
authors.lastname: Martinez
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Hahn
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Robin
authors.initials: R
authors.lastname: Famiglietti
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX dakuban@mdanderson.org.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kuban
mesh_terms: D000046:Academic Medical Centers / Q000592:standards*; D002173:Cancer Care Facilities / Q000592:standards*; D006801:Humans; D008485:Medical Audit / Q000379:methods; D018024:Peer Review, Health Care / Q000379:methods; D011787:Quality of Health Care; D018787:Radiation Oncology / Q000592:standards*