To the Editor.—
As project director for the Department of Defense's civilian external peer review program, I was pleased to note your November 11th publication of both the preliminary article by Mayer and colleagues1 as well as Dr Kelly's2 astute editorial. When I was first called regarding heading up the project in early 1987,I saw a basic structure and process, as Dr Kelly notes in his editorial, that held promise as a "laboratory" model for quality review of large health care systems. While our first charge from the Department of Defense was to ascertain whether care standards were being met in individual cases, we perceived several elements— automated medical record abstracting, criteria-driven data sets, independent expert peer panels, and the potential for development of statistical quality analysis—that we felt could evolve to a far more sophisticated approach than that envisioned by simple case adjudication. I was particularly intrigued
Merry MD. The Department of Defense's External Civilian Peer Review of Medical Care. JAMA. 1989;262(14):1950–1951. doi:10.1001/jama.1989.03430140064019
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