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Allocation of Physicians to Review Type – Off-Site or On-Site Reviews

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Preamble

The College of Physicians of Nova Scotia, by way of the provincial Medical Act must ensure physicians participate in a practice assessment program. As such, the College’s Peer Review Program aims to promote a culture of continuous quality improvement within the profession, enhance competence and ensure the provision of safe medical care.

Guided by the emerging body of literature linking practice quality to a physician’s individual and practice factors, our Peer Review program streams physicians according to “need”. Using a modified Delphi approach, we advanced a “physician factors rubric” designed to stream physicians into two levels of assessment intensity. A physician with more risk factors such as advanced age, professional isolation, lack of certification and repeated disciplinary issues is directed to a high need “onsite practice review”. A physician with more supports in practice, such as evidence of directed continuing professional development, practicing within a shared or team environment and teaching is directed to a less intensive low need or “off-site” practice review.

Eligible physicians are initially assigned to a Peer Review stream based on their predicted need for a practice assessment to identify areas for Quality Improvement.

Figure 1: Peer Review Program Flow Diagram – 2020

Policy

Completed low-need (off-site) assessments will be reviewed by a College-appointed Peer Reviewer against pre-determined criteria. Those with few or no concerns will be considered complete. The physician will be provided with a written report with feedback and contacted by the Peer Reviewer for an interview over telephone or videoconference. The purpose of the interview is to discuss the report and to assist the physician in the development of a Physician Practice Improvement plan that is centred around their Continuing Professional Development.

Reviewed physicians may be changed from low to high need streams under the following circumstances:

  • The documentation provided by the physician in the course of a low need review is insufficient to draw a clear conclusion regarding the quality of practice or provide meaningful feedback for practice improvement;
  • A completed low-need review raises questions or concerns that can only be properly addressed by a more comprehensive practice review; or
  • Randomly, for the purpose of program quality assurance.

High-need (on-site) assessments will be conducted by a College-appointed Peer Reviewer and considered against pre-determined criteria. Those with few or no concerns will be deemed complete. The physician will be provided with a written report with feedback and contacted by the Peer Reviewer for an interview over telephone or videoconference. The purpose of the interview is to discuss the report and to assist the physician in the development of a Physician Practice Improvement plan that is centered around their Continuing Professional Development.

Reviewed physicians will be referred to the Peer Review Committee (PRC) under the following circumstances:

  • Information gathered in the course of the review is insufficient to draw a clear conclusion regarding the quality of practice or provide meaningful feedback for practice improvement;
  • A review raises concerns regarding the quality of practice or approach to practice improvement, sufficient to merit consideration of directed peer support and/or early reassessment; or • Randomly, for the purpose of program quality assurance.

Approved by: Peer Review Committee; Assessment Committee; Council

Approval Dates: June 19, 2020; September 11, 2020; October 9, 2020

Review Date: June 2022