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February 16, 2000

The National Practitioner Data Bank and the Quality of Peer Review—Reply

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(7):886-887. doi:10.1001/jama.283.7.882

In Reply: Dr Frable illuminates the conflict that rural (and urban) physicians can experience when they serve as members of their hospitals' credentialing committees, reviewing the performance of physicians who are their business partners, referral sources, and friends. The conflicts of interest inherent in more intimate, rural health care systems provide strong barriers to the peer review process. Recognizing this, a consortium of 43 Iowa hospitals developed a provider-based statewide physician peer review program.1 This collaborative demonstration project of the Institute for Quality Healthcare, the University of Iowa, and The Robert Wood Johnson Foundation provides hospitals with the opportunity to use specialty-specific physician peer reviewers from outside their own staffs to conduct reviews. Developing anonymous internal reporting systems along with external review such as that developed in Iowa may help overcome the barriers that many hospitals experience with their peer review processes.