The Assessment Process

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The Peer Review Process - General Information

The Peer Assessment Committee (PAC) is mandated by the College of Physicians and Surgeons of New Brunswick to provide for physician peer review in the province. The program operates at arm’s length from the College, and continues the work begun in 1993 by the now-dissolved Atlantic Provinces Medical Peer Review.  The PAC will strive to assess physicians on a regular basis to achieve a mean frequency of every five years, to a maximum of ten years.  Risk factors established by the Committee will ultimately be used to determine the frequency of assessment for individual physicians; those with higher risk factors will be assessed more frequently.

 

 

The Selection Process - Pre-screening

Each year, the Peer Assessment Committee (PAC) selects physicians to be assessed through the onsite or offsite review process. In order to provide adequate and appropriate information to determine if a physician is eligible to be reviewed at that time, physicians being considered are required to complete a “Physician Profile” form.  Those physicians determined to be eligible are subsequently asked to complete a detailed “Supplemental Information for Assessment” questionnaire to give the PAC and the assessor assigned to the review more information about the physician and the type and scope of the practice. It should be noted that participation in the peer review process is mandatory under the Medical Act.

Example of the Physician Profile

Example of the Supplemental Information for Assessment Form

Onsite Assessment

 

 

In an onsite assessment, an assessor is named to visit the practice, a process which usually requires about three hours, and includes a review of patient files selected at random by the assessor.  Following the chart review, the assessor will meet with the physician for about an hour to discuss the impressions reached from the review.  Although physicians may be present for the entire process if desired, their presence is only actually required for the interview portion. in which the assessor will discuss the strengths and weaknesses of the practice and outline possible areas for improvement.  As part of the interview, the assessor will also advise the physician whether he/she will be recommending to the Peer Assessment Committee that the practice is:   Category  1: satisfactory – no further action; or Category  2:   unsatisfactory –  deficiencies identified.

Following the visit, the assessor’s written report is submitted to the Peer Assessment Committee, which will review all reports with “unsatisfactory” recommendations to determine next steps. The Committee may determine that a reassessment is required within a specified time frame; that CPD in specific areas is required;  or that a personal interview and a second look at the charts is necessary. Physicians normally receive the results of the review about three months or so following the onsite visit.

Below are samples of the forms used for onsite assessment. These forms are for information only.  

Note: report forms are used with the permission of the College of Physicians and Surgeons of Ontario. We thank them for their support and generosity.

 

 

 

 

Offsite Assessment

Offsite assessment is less in-depth than onsite review; it is a process which has been piloted and statistically proven to be a valid first-level review tool designed for physicians with a previous history of successful peer reviews, and occasionally for new physicians. It is currently limited to a small number of office-based practices including Cardiology, Family Medicine, Internal Medicine, Obstetrics & Gynaecology and Paediatrics. Consideration of demographic factors, along with a chart review, make up the offsite assessment process.

Physicians being assessed are asked to submit the “Supplemental Information for Assessment” questionnaire and copies of five patient charts, chosen from among patients with specific disease entities relative to the practice.

The type of charts to be submitted is noted in the “Instructions to Physicians” below.  For example, Family Physicians will be requested to include Hypertension, Chronic Pain and Type II Diabetes.  Paediatricians send charts from patients with Autism, Asthma and Seizure Management. An experienced assessor will evaluate the structure and contents of the charts, as well as the management of the disease entities, to determine if the practice appears to be satisfactory, or whether an onsite visit is required.  It is important to note that the PAC will not normally provide physicians with the offsite assessment option each time they are reviewed. It is likely that a physician with a successful onsite review will be offered offsite the next time (s)he is eligible (in 5-7 years), but onsite again the time following.

Below are the forms used for offsite assessment. These forms are for information only.