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The article describes three approaches to establishing an ambulatory audit program for nursing. These approaches are variations of a single methodology--that of the Joint Commission on Accreditation of Hospitals--used by the University of Minnesota Hospitals and Clinics. The authors discuss three audit topics from ambulatory care; postkidney transplant; desensitization; and well child.
There are similarities between the research process and problem-solving-evaluation mechanisms already in use in nursing service. The author describes the utility of each process and the rationale for implementing research in the nursing service setting. The nursing auit is recommended as the intstitutional mechanism for implementing and sustaining research activities.
The introduction of a computerized medical information system as part of a project assessing quality in primary care required the coding of drugs prescribed. The development of a simple four-digit system is described, coding drug, therapeutic class, and route of administration. The system allows easy measurement of the use of combined preparations.The drugs used for insomnia and acute bronchitis have been analysed. The results show marked variation with the age of the patient.The potential for medical audit is discussed as it is now possible to link prescribing figures in routine primary care with relevant clinical information.
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Technology has been made the scapegoat for the increasing cost of health care. Government action in the form of congressional legislation, administrative regulations, funded research, health care payments, etc., has been an important contributing factor in this increasing cost. Microcomputer/microprocessor-based systems such as MUMPS, PROMIS, COSTAR, GeMSAEC, and ASPECT have underutilized potential for producing economies of scale. Quantitative comparative cost data should be developed by every government-sponsored study or project to forcefully prove that more technology results in lowered costs.
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A code form for genetic patient data has been devised for computer purposes. This form provides for the clinical and laboratory diagnosis of genetic diseases. A Hewlett-Packard 2100 computer is used for storage and retrieval of the data. Three programmes are currently in use for the retrieval of data, namely programme RETREV, for retrieval of individual patient records; programme STAT9A, for the classification of chromosome results of patients referred with similar clinical diagnoses; and programme STA12A, for classification of chromosome abnormalities and for correlation with the indication for referral and other data. The possibilities for expansion of the programmes are discussed.
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Owing to the multidisciplinary character of general practice, there is a great need for an effective and practical clinical record system for the family physician. The recording of clinical data of home visits and other visits places an extra burden on his record system. A practical system which tries to solve these and other problems is presented. A simplified form of Weed's Problem Orientated Medical Records (POMR) is incorporated in this system. The different components as well as the practical functioning of the system are described.
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