title: The effect of peer review on mortality rates.
abstract: OBJECTIVE
  Lowering of mortality rates in hospitals with mortality rates higher than accepted reference values for acute myocardial infarction (AMI), congestive heart failure (CHF), pneumonia, stroke, mechanical ventilation (MV) and colorectal surgery by using an external peer review process that identifies areas requiring rectification and implements protocols directed at improving these areas.
  
  
  METHODS
  Retrospective, observational, quality management study using administrative data to compare in-hospital mortality rates (pre and post an external peer review process that included adoption of improvement protocols) with reference values.
  
  
  METHODS
  German general hospitals of a large, private group.
  
  
  METHODS
  Hospitals with mortality rates higher than reference values.
  
  
  METHODS
  Peer review of medical records by experienced, outside physicians triggered by in-hospital mortality rates higher than expected. Inadequacies were identified, improvement protocols enforced and mortality rates subsequently re-examined.
  
  
  METHODS
  Mortality rates 1 year before and 1 year after peer review and protocol use.
  
  
  RESULTS
  For AMI, CHF, pneumonia, stroke, MV and colorectal surgery, the mortality rates 1 year post-peer review were significantly decreased as compared to pre-peer review mortality rates. The standardized mortality ratio for all of the above diagnoses was 1.45, 1 year before peer review, and 0.97, 1 year after peer review. The absolute risk reduction of 7.3% translates into 710 deaths in this population which could have been prevented.
  
  
  CONCLUSIONS
  Peer review triggered and conducted in the manner described here is associated with a significant lowering of in-hospital mortality rates in hospitals that previously had higher than expected mortality rates.
authors.affiliation: HELIOS Hospital Zerbst, Friedrich-Naumann-Str. 53, 39261 Zerbst, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Krahwinkel
authors.affiliation: HELIOS Kliniken GmbH, Friedrichstr. 136, 10117 Berlin, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Schuler
authors.affiliation: HELIOS Hospital Gifhorn, Campus 6, 38518 Gifhorn, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Liebetrau
authors.affiliation: HELIOS Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Meier-Hellmann
authors.affiliation: HELIOS Hospital Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Zacher
authors.affiliation: HELIOS Kliniken GmbH, Friedrichstr. 136, 10117 Berlin, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Kuhlen
mesh_terms: D005858:Germany / Q000453:epidemiology; D006801:Humans; D009026:Mortality / Q000639:trends*; D010380:Peer Review
keywords: in-hospital mortality; peer review; quality indicators