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PubMed2005

Is audit research? The relationships between clinical audit and social-research.

PURPOSE: Quality has an established history in health care. Audit, as a means of quality assessment, is well understood and the existing literature has identified links between audit and research processes. This paper reviews the relationships between audit and research processes, highlighting how audit can be improved through the principles and practice of social research. DESIGN/METHODOLOGY/APPROACH: The review begins by defining the audit process. It goes on to explore salient relationships between clinical audit and research, grouped into the following broad themes: ethical considerations, highlighting responsibilities towards others and the need for ethical review for audit; asking questions and using appropriate methods, emphasising transparency in audit methods; conceptual issues, including identifying problematic concepts, such as "satisfaction", and the importance of reflexivity within audit; emphasising research in context, highlighting the benefits of vignettes and action research; complementary methods, demonstrating improvements for the quality of findings; and training and multidisciplinary working, suggesting the need for closer relationships between researchers and clinical practitioners. FINDINGS: Audit processes cannot be considered research. Both audit and research processes serve distinct purposes. ORIGINALITY/VALUE: Attention to the principles of research when conducting audit are necessary to improve the quality of audit and, in turn, the quality of health care.

Health Services↗
PubMed2000

Access audit trails: en route to security.

An electronic access audit trail can be an effective security tool if the right conditions are in place. In this article, learn how to ensure that your organization has the right technology, procedures, mechanisms, and plans to implement an audit trial.

Authorship↗
PubMed2006

Assessing the outcome of the management of diabetic foot ulcers using ulcer-related and person-related measures.

OBJECTIVE: The purpose of this study was to compare different outcome measures in the audit of management of diabetic foot ulcers RESEARCH DESIGN AND METHODS: Data collected prospectively in a consecutive cohort of patients referred to a specialist multidisciplinary foot care clinic between 1 January 2000 and 31 December 2003 were analyzed. A single index ulcer was selected for each patient and classified according to both the Size (Area and Depth), Sepsis, Arteriopathy, and Denervation [S(AD)SAD] and University of Texas (UT) systems. Ulcer-related outcomes (healing, resolution by ipsilateral amputation or by death, and persisting unhealed) were determined at 6 and 12 months and compared with patient-related outcomes (survival, any amputation, and being free from any ulcer) at 12 months. RESULTS: In 449 patients (63.7% male, mean age 66.7 +/- 13.2 years), 352 (78.4%) ulcers were superficial [S(AD)SAD/UT grade 1] and 134 of these (38.1% of 352) were neither ischemic nor infected. A total of 183 (40.8% of 449) ulcers were clinically infected, and peripheral arterial disease was present in 216 patients (48.1%). Seventeen patients (3.8%) were lost to follow-up and were excluded from analysis. Of the ulcers, 247 (55.0% of 449) and 295 (65.7%) healed without amputation by 6 and 12 months, respectively. Median (range) time to healing was 78 (7-364) days. Of all index ulcers, 5.8 and 8.0% were resolved by amputation, and 6.2 and 10.9% by death by the same time points; 27.8 and 11.6% persisted unhealed. In contrast, patient-related outcomes revealed that of 449 patients only 202 (45.0%) were alive, without amputation, and ulcer free at 12 months. This group had had 272 (1-358) days without any ulcer. A total of 48 (10.7%) patients had undergone some form of amputation, and 75 (16.7%) had died. CONCLUSIONS: These data illustrate the extent to which ulcer-related outcomes may underestimate the true morbidity and mortality associated with diabetic foot disease. It is suggested that when attempts are made to compare the effectiveness of management in different centers, greater emphasis should be placed on patient-related outcome measures.

Aged↗
PubMed1998

The effect of education, assessment and a standardised prescription on postoperative pain management. The value of clinical audit in the establishment of acute pain services.

A study involving 2738 patients in 15 hospitals in the United Kingdom was undertaken to evaluate the effect of simple methods of pain assessment and management on postoperative pain. The study consisted of four parts: a survey of current practice in each hospital; a programme of education for staff and patients regarding pain and its management; the introduction of formal assessment and recording of pain and the use of a simple algorithm to allow more flexible, yet safe, provision of intermittent intramuscular opioid analgesia; and a repeat survey of practice. One hospital from each of the former health regions of England and Wales was selected for inclusion in the project. Hospitals included representatives of different size units (university, large and small district general hospitals). As a result of the study, there was an overall reduction in the percentage of patients who experienced moderate to severe pain at rest from 32% to 12%. The incidence of severe pain on movement decreased from 37% to 13% and moderate to severe pain on deep inspiration from 41% to 22%. Similar decreases were seen in the incidence of nausea and vomiting. There was also a slight reduction in the incidence of postoperative complications. This study shows that simple techniques for the management of postoperative pain are effective in reducing the incidence of pain both at rest and during movement and should form part of any acute pain management strategy.

Analgesics, Opioid↗
PubMed1999

Improvement and renewal of healthcare processes: results of an empirical research project.

Professionals in healthcare organizations, who generally produce high-quality work, commonly operate in isolation or locally. However, due to developments in society and legislation, healthcare organizations are forced to integrate healthcare activities, and achieve integral quality management, instead of suboptimal, local quality management. Eindhoven University of Technology set up a study in 11 Dutch healthcare organizations in the area of interface management. The study was performed in general and mental hospitals, and clinics for care and treatment of drug addicts. The research projects aimed to develop methods to achieve an improvement or a renewal of healthcare processes. Special attention was paid to the interfaces between departments and individual parts of the healthcare process. In this paper an outline is given of both the improvement and the renewal approach, results of three of the 11 case studies are presented (as an example) and the improvement and the renewal approach are compared with respect to healthcare processes.

Benchmarking↗
PubMed1999

Quality management in Irish health care.

This paper reports on the findings from a quantitative research study of quality management in the Irish health-care sector. The study findings suggest that quality management is what hospitals require to become more cost-effective and efficient. The research also shows that the culture of health-care institutions must change to one where employees experience pride in their work and where all are involved and committed to continuous quality improvement. It is recommended that a shift is required from the traditional management structures to a more participative approach. Furthermore, all managers whether from a clinical or an administration background must understand one another's role in the organisation. Finally, for quality to succeed in the health-care sector, strong committed leadership is required to overcome tensions in quality implementation.

Attitude of Health Personnel↗
PubMedDate not supplied

A structure for organizing a facility's annual performance review.

A facility's annual appraisal or report historically has evaluated the traditional quality assurance (QA) role of morbidity and mortality, infection control, tissue review, and medical record data. With the evolution of QA to performance improvement (PI), the traditional annual appraisal has had to expand to address multiple organizational programs, projects, and indicators, as well as the structure and outcome of teams. This article discusses a structure for evaluating various programs and reviewing how well the organization has met its goals.

Annual Reports as Topic↗
PubMedDate not supplied

Key principles of quality management for health information departments and their managers.

This article briefly summarises the key factors essential for successful quality management in a medical record department. The article suggests that health information managers should play a larger role in overall hospital quality management and their credibility in this activity would be enhanced if they were to first look to their own departments.

Australia↗
PubMed1997

How does HEDIS affect quality improvement strategies in an HMO?

To meet the demands of the marketplace, health plans devote considerable resources to comply with Health Plan Employer Data and Information Set (HEDIS) reporting standards and to improve performance along those measures. Given HEDIS's growing prominence, one might question whether it plays a major role in the formulation of an HMO's quality improvement strategies. The experience at NYLCare Health Plans, Inc., suggests that quality improvement strategies should focus on strengthening the ability of HMOs to meet the more general agenda of quality measurement and improvement, and not just requirements specific to HEDIS.

Health Benefit Plans, Employee↗
PubMed1998

Spider diagram helps hospital cut the fat using clinical quality and patient satisfaction data.

A balancing act: When it became apparent that a 900-bed hospital in Detroit needed to cut costs to stay viable, leaders decided making across-the-board cuts would be as dangerous as making no cuts. Instead, they began measuring four different types of indicators on a new service-line basis using a spider diagram to ensure they were balancing the needs of administration, physicians, patients, and the community.

Benchmarking↗