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Objective—Concurrent peer review visits are structured office visits conducted by clinician
peers of the primary care clinician that are specifically designed to reduce competing demands,
clinical inertia, and bias. We assessed whether a single concurrent peer review visit reduced
clinical inertia and improved control of hypertension, hyperlipidemia, and diabetes control among
underserved patients.

Methods—We conducted a randomized encouragement trial to evaluate concurrent peer review
visits with a community health center. Seven hundred twenty-seven patients with hypertension,
hyperlipidemia, and/or diabetes who were not at goal for systolic blood pressure (SBP), low-
density lipoprotein cholesterol (LDL-C), and/or glycated hemoglobin (A1c) were randomly
assigned to an invitation to participate in a concurrent peer review visit or to usual care. We
compared change in these measures using mixed models and rates of therapeutic intensification
during concurrent peer review visits with control visits.

Results—One hundred seventy-one patients completed a concurrent peer review visit. SBP
improved significantly (p < .01) more among those completing concurrent peer review visits than
among those who failed to respond to a concurrent peer review invitation or those randomized to
usual care. There were no differences seen for changes in LDL-C or A1c. Concurrent peer review
visits were associated with statistically significant greater clinician intensification of blood
pressure (p < .001), lipid (p < .001), and diabetes (p < .005) treatment than either for control visits
for patients in either the nonresponse group or usual care group.

Conclusions—Concurrent peer review visits represent a promising strategy for improving blood
pressure control and improving therapeutic intensification in community health centers.

cardiovascular; health care; minority health