Does hypertension management audit provide cues for cost containment? Hypertension Management Audit Project Group.
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Cost Control↗
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[Determination of prevalence and control level of hypertension in the community: Hypertension Management Audit Project--Vicenza].
As a part of the "Hypertension Management Audit Project" a random sample of 4070 subjects was drawn from the population aged 35-64 living in the city of Vicenza, in order to assess the prevalence and the level of control of hypertension in the community. 2854 (70.1%) were screened in the first step of the survey. Two blood pressure (BP) reading, height and weight measurements were performed and a short questionnaire filled in. Systolic BP (SBP) and diastolic BP (DBP) were (mean and 95% confidence interval) 143.7 (142.6-144.7) and 88.3 (87.7-88.8) mmHg in males; 137.8 (136.8-138.8) and 84.9 (84.5-85.5) mmHg in females, respectively. The BP value corresponding to the 95 degrees percentile of the cumulative distribution of BP was 180 mmHg for SBP and 105 mmHg for DBP in males; 173 mmHg for SBP and 100 mmHg for DBP in females. Systo-diastolic hypertension was present in 12.3% of the screened population; isolated diastolic hypertension in 9.1%; isolated systolic hypertension in 5.3%; borderline hypertension in 31.6%; severe hypertension (DBP > or = 115 mmHg) was present in 1.9% of females and in 2.2% of males. Prevalence in males was significantly higher with respect to females in all three categories of defined hypertension, but not in borderline hypertension. The second step of the survey involved 849 subjects (29.7% of the screened population) who completed two re-examinations because at the screening they had: 1) history of high BP; 2) BP > or = 160/95 mmHg; 3) ongoing antihypertensive treatment. At the end of the survey, 772 of these subjects (91%) were confirmed as hypertensives (mean BP of six readings > or = 140/90 mmHg and/or taking antihypertensive drugs). Patients aware of their high BP were 78.8%; aware and treated 51.0%; treated and controlled (BP < 140/90 mmHg) 19.1%. All indices of control were significantly higher in female with respect to male patients. Treated patients were significantly older than untreated patients; treated females had significantly lower BP than treated males, whereas no difference was detected between untreated patients; patients unaware of high BP had the highest BP values if compared to treated and untreated patients. This survey reveals a high prevalence of hypertension in the adult population of the city of Vicenza; quality of control shows a moderate improvement if compared to previous studies carried out in our country.
Adult↗
Impediments to the control of hypertension. Hypertension Management Audit Group.
Despite the great therapeutic advances, the control of hypertension in populations is far below the achievable level, even in populations with highly developed health care. By the end of the 1980's, in selected European centres, 18-34% of cases of hypertension were undetected, and among those previously known, 22-38% were untreated. The cooperative WHO/WHL Hypertension Management Audit Project aimed at assessing some of the impediments to better control of hypertension. The concepts and attitudes of 2,215 physicians were surveyed. In various centres and at various patient ages, 25-45% of physicians would not start drug treatment below 100 mm Hg. When inquiring into the perceived reasons why hypertension had not been detected earlier, among other reasons, physicians tended to incriminate their workload, while patients often felt that there was a lack of interest on the doctor's part to take a blood pressure reading. In general, patient satisfaction seemed suboptimal. Physician's sources of information were varied; neither WHO, nor ISH or WHL seemed to play an important role in informing the physicians.
Adult↗
Practice management audit--a painless, and profitable, proposition.
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Accounting↗
Legal aspects of orthodontic practice: risk management concepts. Performing a risk management audit of your practice.
In this and succeeding issues of the AMERICAN JOURNAL OF ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS, factual risk management scenarios will be presented. These scenarios are based on composites of actual court cases that have been tried to verdict or decision. Valuable risk management lessons may be learned from careful analysis of the course of the events described. Please be advised that the standard of care determined in any case is specific for that jurisdiction and that set of facts as established by expert testimony for the prevailing party. Readers' comments may be addressed to Dr. Donald E. Machen, 5801 Beacon St., Pittsburgh, PA 15217.
Costs and Cost Analysis↗
Nursing management audit: the reaction of users.
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Clinical Competence↗
Management audit - the Exeter method.
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England↗
Management peer review audits efficiency.
A medical center's voluntary management audit program helps to assess and to ensure efficient and effective institutional and departmental management.
Consultants↗
The psychiatric discharge summary: a tool for management and audit.
The aims of this study were to review the information needs of general practitioners in relation to the discharge of mentally ill patients; to design a discharge summary that would meet these needs and evaluate its use by junior hospital staff; and to assess the usefulness of this summary for audit. The information needs of general practitioners were identified from a review of the literature and from discussions with local general practitioners. A prototype discharge summary was designed and reviewed by a panel of general practitioners, regional advisors and course organizers from the south east Thames region. It was used for all patients discharged from the acute psychiatric ward in Hither Green Hospital over a 10 month period. One copy was given to the patient to take to the general practitioner, one was posted to the general practitioner and a final copy was kept in the patient's hospital records. The senior house officers found the summary easy to complete. It reduced uncertainty about what data to provide, and helped to focus on the most critical information needed by general practitioners for continuity of care. Using a pre-coded data collection sheet, analysis of the information on the summaries was easily done. It provided a rapid audit of caseload, diagnoses, therapy, methods of admission and discharge, length of stay, risk factors and roles of all involved in future management. This information can be of use to the psychiatric team, general practitioners and hospital managers and could be the first step towards the development of shared care.
Communication↗
The use of routine referral data in the development of clinical audit and management in North Lincolnshire.
As part of the national waiting list initiative, a retrospective survey of routine referrals in seven specialties to Lincoln County Hospital by general practitioners within its catchment area, during the months of January to March 1987 inclusive, was carried out, using data from the hospital's Patient Administration System and the Lincolnshire Family Practitioner Committee. These specialties were identified by managers and clinicians as those in which a significant problem of waiting times and waiting lists existed, both as perceived locally and in comparison with other districts. The total referral rate for all GPs in the study was 9.6 referrals/100 patients on their list/year, which is very close to the average of other studies published elsewhere in the country on this topic. However, the range of referral rates between practices was very wide, varying from 2.8 to 17.6. There were also wide variations within individual practices. It is therefore concluded that, taken overall, 'over-referral' by general practitioners is not the cause of any problem at Lincoln County Hospital. However, the wide variation of referral patterns has been of great interest to the general practitioners themselves. They have requested that referral rates be fed back to them routinely, in the manner of the Prescription Pricing Authority, and this will commence shortly. In addition, a working group of orthopaedic surgeons and general practitioner representatives has met to discuss the implications of the study, and the drawing up of mutually agreed referral protocols, the operation of which would be monitored jointly. The setting up of similar groups in the other specialties is under active consideration.
Catchment Area, Health↗
Assessment of hypertension levels control and management (hypertension "AUDIT" project). Study in a population of workers.
The hypertension AUDIT project (WHO) was used for the study of large populations of workers in two Romanian industrial centers, Slatina and Sibiu, constituted into two main groups. The objects of the study were: the detection of new cases of arterial hypertension (AH) and of their proportion as compared with older cases, the assessment of the quality of diagnosis control and treatment methodology as well as the estimation of the patient's attitude regarding the conditions of treatment and of the physician's knowledge and attitude regarding AH. Group I (Slatina) included 22,839 workers and the program was applied in 15,740 randomly chosen subjects. Group II (Sibiu) included 14,874 workers of whom 2,838 were randomly chosen for study. From a total of 606 (6.20%) subjects aged 35 to 64 years with AH in both groups, 494 (81.51%) were older cases and 112 (18.48%) were newly detected. The prevalence of AH was found to increase with age and to be higher in women aged 55 to 64 years. The treatment in older cases from both groups was considered effective in 232 cases (46.96%) (of which 26 (11.2%) with overtreatment) and insufficient in 262 (53%). The reasons alleged by the patients for the late detection of AH were the absence of symptoms and a casual interest for their state of health. The risk factors were systematically checked. Smoking was found in 30.36% of the subjects in group I and in 31% of those in group II. The use of diagnostic laboratory procedures was corresponding to the present recommendations. The nonpharmaceutic therapy was frequently recommended, especially reduction of salt consumption. Besides that, pharmaceutic treatment was indicated in most of the patients (63% in group I and 90% in group II). Diuretics (41.26% in group I and 75% in group II), and beta blocking drugs (35.3% in group I and 70% in group II) were the most frequently administered and in a lesser proportion vasodilators with central or peripheral action, calcium blockers, Rauwolfia and angiotensin conversion enzyme inhibitors. The consumer inquiry showed satisfactory compliance of patients, most of them took their tablets regularly, were satisfied with the medical assistance and preferred to consult the same physician. The data of the physician inquiry regarding diagnosis treatment of AH and professional training also proved satisfactory. The use of the AUDIT project has allowed a complex estimation of AH in the groups studied and will prove useful for a more efficient control of AH in the whole population.
Adolescent↗
An audit of the management of malaria in a Tanzanian district hospital.
An audit of the management of falciparum malaria was carried out over a 12 month period in a north-west Tanzanian district hospital; 1494 patients were studied, 75% being children under 5 years. Chloroquine was effective in 1128 cases (79%), 68 patients died, of whom 64 were aged under 5 years; 30 of them died fewer than 2 d after admission; 14 had received quinine chemotherapy. Management can be improved by better diagnosis of anaemia and hypoglycaemia, changing the dose of injectable chloroquine, earlier use of quinine, and enabling doctors to see very ill patients earlier.
Child↗
Creating a total quality health care environment.
Until recently, health professionals lacked incentives to integrate internal management processes, depending instead on external quality assurance and regulatory standards. Competitive markets and increased regulatory pressures now encourage managers to reorient systems from a cost-driven reimbursement approach to the implementation of Total Quality Care as a management strategy.
Costs and Cost Analysis↗
Hypertension, obesity and response to antihypertensive treatment: results of a community survey.
A random sample of 2,854 subjects aged 35-64 was examined in the town of Vicenza (Italy) as part of the 'Hypertension Management Audit Project'. Pearson's correlation coefficient and multivariate analysis considering systolic and diastolic blood pressure, age and body mass index (BMI) were performed. SBP was more closely correlated with age than DBP. BMI correlated with both SBP and DBP, but very little with age. Fifty-seven percent of the men had a BMI of 25.5 or more and 49% of the women had a BMI of 24.5 or more. The quality of BP control in the treated patients was worse in the overweight when compared with the lean patients, although overweight and lean patients are treated with the same frequency.
Adult↗
Health service performance indicators.
The development of statistical indicators for monitoring performance throughout the National Health Service began in 1981. In recent years, computer software packages containing performance indicators have been amended to include Health and Social Services Boards in Northern Ireland. Although this information is available to anyone with an interest in service provision, the main purpose of the indicator packages is to provide a framework and discipline for ensuring proper accountability to a higher tier authority.Efficiency and effectiveness are concepts central to performance appraisal. Most performance indicators are concerned with the input of resources or treatment activity rather than health outcome. Consequently the context within which the accountability review procedure operates is predetermined towards efficiency. The validity of the review process is limited by the accuracy of the indicators and the manner in which they are interpreted. The scale at which performance indicators function and the constraints associated with their use as an analytic tool are illustrated using data from a mental illness hospital in Northern Ireland.
Efficiency↗
Guidelines for good practice in and audit of the management of upper gastrointestinal haemorrhage. Report of a joint working group of the British Society of Gastroenterology, the Research Unit of the Royal College of Physicians of London and the Audit Unit of the Royal College of Surgeons of England.
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Acute Disease↗