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Peer review in health services research: issues and problems.

Peer review as a means of assuring high quality research was the invention of Cassius J. Van Slyke, Deputy Director of the National Institutes of Health during its formative years. At that time, senior NIH officials foresaw the possibility that Congress, then generous and supportive, would one day hold them accountable for the expenditure of billions of dollars on biomedical research. Accordingly, Van Slyke organized study sections, composed of the applicant's professional peers drawn from settings outside of government, to evaluate the scientfic merit of research proposals [1].1 Study section members were directed to judge a proposal in terms of the significance of the problem to be studied, the appropriateness of the methods to be used for data collection and analysis, and the investigators' qualifications for successfully completing the research. Questions about the relevance of the research to NIH's mission or Congressional intent were left to advisory councils and, ultimately, to the NIH staff who made funding decisions. More recently, the NIH model has spread from the biomedical research institutes to other agencies of government where research on the organization and financing of health services is a major concern. These include the National Center for Health Services Research, Veterans Administration, and the National Institutes of Mental Health, Aging, Drug Abuse, and Alcohol Abuse and Alcoholism.2