Pilot Study of Peer Review in Low Middle-Income Country (LMIC) through Cloud-Based Platform.

Abstract

Peer review is an essential step in clinical quality assurance and can impact patient safety and treatment outcomes. Most published data on peer review is from developed nations, with little data on peer review from low middle income countries (LMIC). Major challenges to peer review can include a lack of time, expertise and commitment from team members. With increasing access to advanced technology in LMIC, peer review is becoming more important to maintain quality and standard of care. We evaluated cloud-based e- peer review (Varian) in our network of hospitals in India with an aim to see feasibility and impact on care. Four of 15 centers across India were selected for this pilot study. All team members were trained on the platform prior to implementation. New cases for the week treated with definitive intent were selected by the dosimetrist. The link to the cases were sent through email to reviewing physicians. Various aspects which were reviewed for each case were.1) Work up & staging (Documents were scanned and loaded).2) Treatment intent & prescription.3) Target contours.4) Normal Organ at risk contours.5) Dose- Volume -Histogram (DVH) with clinical goals attached. Cases were marked as "Not Appropriate", "Appropriate", "Appropriate with minor finding", "Represent with major revisions" as per volume and plan review. Over a period of 2 months, a total of 80 cases underwent e-Peer Review at our network of hospitals prior to the start of treatment. Median turnover time (like from link sent to time to completion of review) was 48 (6-360) hours. Mean time taken by physician for review was 9 minutes (range 3 to15). 31.2% of cases were accepted without any changes, 51.9 % had a minor change and 16.9 % cases had major changes. Most frequent reason of major changes was contouring corrections 16.9%. 31% of major changes underwent recontouring and replanning before initiation of treatment. Peer review was feasible in our network through this e-peer review system, with average turnover time and mean time taken for review of 48 hours & 9 min respectively. Peer review led to significant changes which could impact patient care delivery and outcome. The ability to review cases asynchronously via this cloud-based e-peer review system, helped to ease the burden of scheduling between treating and reviewing physician. We plan to implement this across the remaining centers in our network.