Quality of Clinical Management of Disease in Comprehensive Neighborhood Health Centers

Abstract

Peer review of clinical management of patients with serious or potentially serious illness was conducted in 40 neighborhood health centers in the fields of medicine, pediatrics, obstetrics, and gynecology. The majority of centers reviewed were performing at a satisfactory level in comparison to similar studies that have been performed on individual practitioners in another setting. Although a few instances were encountered where the specific provider was considered unsatisfactory, the major deficiencies were due to lack of adequately functioning systems: lack of follow-up of positive laboratory and x-ray results, inadequate hospital relationships, and poor patient compliance. No relationship was found between performance ratings and degree of pathology, length of time under care, physician-patient continuity, or whether the program was in an urban or rural area. Centers with strong backup hospital relationships and board eligible or board certified physicians had higher performance ratings than those without such resources. It is of considerable interest that findings of the less sophisticated index type of audit, which can be performed by nonphysicians, correlated reasonably well with the more sophisticated, time-consuming peer reviews which require physician input.