To the Editor.—
Dr Kellys1 excellent editorial comments that followed the article entitled "A First Report of the Department of Defense External Civilian Peer Review of Medical Care"2 raised several points. The integrated quality assurance system that is used by the US Air Force actually goes well beyond civilian external peer review data. Approximately 5% of the cases that "pass" review criteria are also looked at through 1 or more of 20 other quality of care mechanisms.Sharing Dr Kelly's view that "review criteria should be continually validated," quality assurance planners at the Department of Defense set up monthly reviews to do just that when the project was begun. Also sharing Dr Kelly's concern that cases in which no occurrence screening criteria had ostensibly been violated should be checked, the air force performs a verification audit on 5% of all discharges for which no positive occurrences were identified.
Torma MJ. The Department of Defense's External Civilian Peer Review of Medical Care. JAMA. 1989;262(14):1951. doi:10.1001/jama.1989.03430140064020
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