Case Conferences

Case conferences are primarily educational meetings in which physicians review the care of difficult cases. The case may be presented because it was unusual or complex, required difficult clinical management choices, or had an adverse outcome. The discussion may cover a great many topics such as the value of new technologies, approaches to care that might have been more conservative, clinical findings that were overlooked, or an ethical dilemma presented by the case.

The Morbidity and Mortality (M&M) conference is a department-based conference that occurs after an adverse event such as a death or complication, typically after a surgical procedure. The course of illness and diagnostic, autopsy, and pathology findings are presented and discussed by the attending physician and pathologist.

Strengths. Case conferences are highly valued by clinicians as an effective method of learning. They are conducted in a nonjudgmental atmosphere and are considered clinically pertinent. They accord with medical training in that they focus on individual cases.

Limitations. Case conferences are believed to be very effective in monitoring and assuring high quality of care in hospitals. They do not, however, result from or lead to systematic information about practice patterns and outcomes that might advance the institutions’ understanding of patterns of care in unanticipated ways.

Patient Complaints

Reviewing complaints can be a method of detecting problems in care. Responding to complaints may have two valuable functions. It indicates to patients that the organization takes problems seriously, and it may prompt intraorganizational reforms that would never be suggested by formal quality assurance mechanisms. Complaint reporting programs are also used by external regulators, such as state and local departments of health and insurance commissioners. At least one PRO visited in this study believed that patient (or other) complaints were useful in identifying problem practitioners and that PRO review of patient complaints helped foster better relations with the patient community.

Strengths. Review of complaints, like patient assessments, includes patients in the quality review process and permits the identification of unexpected problems. A systematic classification and review of complaints has the potential to identify underservice, including lack of access to services. It can also identify interpersonal issues; like malpractice allegations, com-



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