Peer review. Part 2: The influence of internal and external standards on outcome.

Two peer review groups of ten general practitioners each reviewed their management of two conditions, headache and fatigue. Each group used internal standards which they had set for the review of one condition and external standards set by the other group for the other condition. Data for the review were collected from the general practitioners' case notes and presented to them. The following year their management was again reviewed. Group 1 improved their management of both conditions by 15%. Group 2 improved their management of the condition where internal standards were used by 12% and the condition where external standards were used by 9%. This difference was not statistically significant. Although there was a significant improvement in the management of both conditions in each group, the use of internal versus external standards made no difference to the degree of improvement following peer review.