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We remain gratified with the progress of the Department of Defense's external peer review program, concur with Dr Merry's comments, and offer the observations that follow on Dr Kelly's letter. This external civilian peer review program has reassured us in the way it has assessed various clinical aspects of our total system performance, a vital concern initially. It must be noted, however, that this is only one of several important elements of our total quality assurance effort, which includes, for example, a thorough review and verification of credentials before granting clinical privileges, the evaluation of individual performance at the hospital level, and system-wide tracking of privilege limitations and malpractice claims. In addition, as Dr Kelly recommends, there are mechanisms at various levels to assess patient perceptions of their experiences.This evolving, comprehensive quality assurance program provides a useful precedent in assisting our efforts to integrate clinical outcome, resource
Mayer W, Clinton JJ, Newhall D. The Department of Defense's External Civilian Peer Review of Medical Care-Reply. JAMA. 1989;262(14):1951. doi:10.1001/jama.1989.03430140064021
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