Early Results From the ASTRO Practice Patterns in Peer Review Survey Project

Abstract

Peer review is an important aspect of medical quality assurance and patient safety. There is little published literature on peer review in Radiation Oncology. To establish current peer review practice patterns, evaluate interest in formal recommendation for peer review, and establish a framework for future recommendations, ASTRO proposed a survey of physician members. 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 consisted of 8 demographic items and 25 peer/practice review items delivered using a web-based survey platform including reminders. All ASTRO physician-members and members-in-training worldwide were invited by email to participate in the survey. A total of 5,674 physicians were contacted starting in January 2013. During days 1-23 of the 60 day survey, 561 physicians participated (10%) yielding a +/- 4% margin of error (95% CI). Those responding included 509 staff radiation oncologists, 35 residents/trainees, 265 academic physicians, 25 Government/DoD physicians, and 112 non-US physicians. The mean years-in-practice = 13 (SD 10), mean number of new patients/year = 238 (SD 128), and median practice size = 6 physicians. Overall, 83% of respondents were involved in a peer review program, 75% were comfortable with their program, and 80% felt that peer review was encouraged. Of those involved in peer review, 65% report doing at least some peer review before radiation therapy starts. Of patients treated by these physicians, 56% (SD 35) are reviewed before treatment. Peer review elements reviewed include overall treatment strategy (88%), dose/fractionation (89%), contouring (58%), and isodose/DVH (75%). Peer review is performed using hard copy charts (34%), electronic medical records (63%), and images/isodose plots/DVHs on screen (73%). Eighty-seven percent of physicians have changed radiation treatment plans because of peer review. These providers describe making changes in 9% (SD 14) of cases and report that 3% (SD 5) of cases fall outside the standard of care. Seventy-four percent of physicians agree or strongly agree that ASTRO should make formal peer review recommendations with 7% in opposition to this proposal. Preliminary results from this survey suggest that peer review in Radiation Oncology is common and leads to changes in clinical management in a meaningful fraction of cases. There is much variation in the manner of conducting (e.g. content, timing), and reported utility of, peer review. The vast majority of ASTRO physician members support formal recommendations and guidance on peer review. Full results and analysis will be available for the ASTRO 2013 Annual Meeting.