A Policy-based Approach for Conducting Safety Research with Hospital Peer Review Protected Material

Abstract A multidisciplinary team developed a policy-based approach that provides guidance for using peer review protected information for safety research while maintaining peer review privilege. The approach includes project approval by an ad hoc review committee, signed confidentiality agreements by investigators and study staff, early removal of case identification numbers, standards for maintaining data security, and publication of aggregate data without dataset sharing. By describing this procedure and embedding into an institutional policy on Data for Performance Improvement, we encourage other institutions to develop similar policies consistent with their state regulations.