Peer Review in Obstetrics and Gynecology by a National Medical Specialty Society

Abstract

Since 1986 the American College of Obstetricians and Gynecologists (ACOG) has offered a voluntary consultation service (Voluntary Review of Quality of Care [VRQC] program) to assist departments of obstetrics and gynecology in assessing their quality of care. The VRQC program review team selects three to five topics for on-site medical record review to further investigate the care processes that may contribute to the perceived problems. Each chart is evaluated by a single reviewer with the use of worksheets with explicit, objective criteria that represent practice guidelines. In addition, key departmental and hospital personnel are interviewed on site to provide insight into the issues that prompted the request. The first 100 site visits took place in 29 states and represented a diverse geographic cohort of hospital departments of obstetrics and gynecology. Overall departmental and systemic deficiencies were significantly more common than clinical concerns. Obstetric issues were more prevalent than gynecologic issues. Induction and augmentation of labor was the most common deficiency, and the availability and quality of obstetric anesthesia was the second. The VRQC program, as a voluntary consultative peer review program, addresses hospital-specific quality problems and also identifies common deficiencies across a diverse group of hospitals, which may warrant continuing education.