title: A Systematic Approach to Clinical Peer Review in a Critical Access Hospital.
abstract: Clinical provider peer review (CPPR) is a process for evaluating a patient's experience in encounters of care. It is part of ongoing professional practice evaluation and focused professional practice evaluation-important contributors to provider credentialing and privileging. Critical access hospitals are hindered in CPPR by having a limited number of providers, shortages of staff resources, and relationships among staff members that make unbiased review difficult. Small departments within larger institutions may face similar challenges.
  
  
  
  A CPPR process created at Mayo Clinic Health System is described. It involved a case review questionnaire built on the Institute of Medicine "Six Aims for Changing the Health Care System," a standardized intervention algorithm and tracking tool.
  
  
  
  During 2007 through 2014, a total of 994 cases were reviewed; 31% led to provider dialog and education or intervention. Findings were applied to core measure processes with success rate going from 87% to 97%. Changes were adopted in end-of-life care, contributing to a 50% reduction in all-cause mortality rate.
  
  
  
  Providing peer review tools to a critical access hospital can keep peer review within a group with knowledge of the individual provider's practice and can make process improvement the everyday work of those involved.
authors.affiliation: Department of Family Medicine (Drs Deyo-Svendsen and Phillips), Department of Quality and Utilization Resources (Mr Schilling and Ms Albright), Mayo Clinic Health System-Red Cedar, Menomonie, Wisconsin; and Clinical Services, Allevant Solutions, LLC, Mechanicsburg, Pennsylvania (Mr Palmer).
authors.forename: Mark E
authors.initials: ME
authors.lastname: Deyo-Svendsen
authors.forename: Michael R
authors.initials: MR
authors.lastname: Phillips
authors.forename: Jill K
authors.initials: JK
authors.lastname: Albright
authors.forename: Keith A
authors.initials: KA
authors.lastname: Schilling
authors.forename: Karl B
authors.initials: KB
authors.lastname: Palmer
mesh_terms: D000465:Algorithms; D006739:Hospital Administration / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007318:Inservice Training; D008507:Medically Underserved Area; D010380:Peer Review / Q000379:methods*; D058996:Quality Improvement / Q000458:organization & administration*; D013727:Terminal Care / Q000458:organization & administration