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VA Health Care: Improvements Needed in Processes Used to Address Providers' Actions That Contribute to Adverse Events.

Draper D; Government Accountability Office; GAO.

Evaluation of provider behavior can identify problems that affect patient safety. This report analyzed data and expert interviews from four Veterans Affairs medical centers to identify weaknesses in peer review processes. Investigators found inconsistent adherence to peer review policy elements, such as timely review performance and peer review trigger development, and make recommendations to drive actions that address these issues.