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At least 19 recordsLinked to original sources
PubMed1992

Principles and practice of medical audit (medical care evaluation).

1. Medical audit is a philosophy in the field of medical science which has reached to an advanced stage of practice in Western World, but yet to reach and percolate into Indian medical community. 2. Of late, community is getting increasingly aware of its health rights, gradually community participation in health matters including quantum and quality of case, has started increasing. Thus community leaders have started demanding for quality of medical care and accountability of those, responsible for delivery of medical care at various levels. 3. Medical audit or Evaluation of medical care is an answer to ensure the quality of care. But there are misgivings and distrust about medical audit due to its terminology. 4. There is need to education the medical, nursing and paramedical staff regarding medical audit and its sole purpose of self education and improvement of patient care activity. The present paper spells out fundamentals of medical audit, its scope and limitations.

Community-Institutional Relations↗
PubMed1992

[Standards as basis for medical audit].

Medical audit usually implies evaluation of medical practice in order to control whether certain standards are complied with. Research on decision making has disclosed, however, that standards for clinical problem solving are not always easy to establish. It has been difficult to influence doctors to adhere to standards defined by experts. We therefore propose that medical audit should focus more on education than on control. If standards are to be used, the doctors participating in medical audit projects should also help to define the standards. We suggest the following procedure for medical audit projects: observe practice--reflect on it--identify changes--formulate standards--implement changes--evaluate changes--give feedback to the group about the outcome. Standards defined by experts working remote from medical practice, must be replaced by standards based on practical knowledge acquired by doctors with common experience.

Decision Making↗
PubMed2001

Medical audit: threat or opportunity for the medical profession. A comparative study of medical audit among medical specialists in general hospitals in The Netherlands and England, 1970-1999.

Medical audit has been introduced among hospital specialists in both the Netherlands and England. In the Netherlands following some local experiments, medical audit was promoted nationally as early as 1976 by the medical profession itself and became a mandatory activity under the Hospital Licensing Act of 1984. In England it was the government who promoted medical audit as a compulsory activity for medical specialists, in particular since 1989. In this article the development and introduction of medical audit in the two health care systems is described and its impact on the clinical autonomy of medical specialists gauged. It is concluded that in both countries external pressures seem to have been crucial in the 'compulsory' introduction of medical audit. Although there are differences in the organisation and culture of the medical profession in the two countries, in both countries medical audit turned out to be an instrument 'controlled' by the profession itself. The question whether medical audit is instrumental in preserving clinical autonomy has also been addressed. Our conclusion is that in its present form medical audit in the two countries has not been a threat to the clinical autonomy of the medical profession. At the same time it is clear that the study of one quality instrument is insufficient to draw conclusions about the development of clinical autonomy, let alone autonomy in general. Moreover, it remains to be seen how medical audit can survive alongside quality improvement mechanisms such as accreditation, certification, performance indicators and formal quality systems (ISO, EFQM) where hospital management executes more control. The history of medical audit in the Netherlands and England over the past 30 years does illustrate, however, the capability of the profession to maintain autonomy through re-negotiated mechanisms for self-control.

England↗
PubMed1976

Medical audit, continuing medical education and quality assurance.

Medical audit and continuing medical education (CME) are now the mainstays of quality assurance in hospitals. Audits should address problems that have serious consequences for patients if proper treatment is not given. The single most important step is the selection of essential or scientific criteria that relate process to outcomes. CME does less than commonly believed to improve care. Today, quality assurance increasingly means a near-guarantee to every patient of appropriate treatment and fewest possible complications. Maintenance of the public trust rests on a firm commitment of the medical staff and board to this principle, implemented through an organized program of quality assurance. Under these conditions, medical audit and CME can effectively improve care by improving physician performance.

Education, Medical, Continuing↗
PubMed1986

Audit of the Medical Audit Committee.

We reviewed 39 medical audits started in one institution between 1981 and 1985 to determine whether they monitored the quality of health care in a scientific manner, whether recommendations were made that could improve the quality of health care and, if so, whether the recommendations were acted on. Thirty-three audits (85%) were completed; 21 (64%) failed to state their objectives, 30 (91%) failed to compare their results with those in the literature, 9 (27%) made no recommendations that could improve the quality of health care, and 9 were poorly researched and written. The number of patients in each audit was usually adequate. Feedback was rarely received by the Medical Audit Committee concerning the Medical Advisory Committee's response to the audit. Information concerning the implementation of recommendations was available for 17 of the 24 audits that made recommendations; 7 (41%) had failed to implement half or more of the recommendations. Despite these problems, 8 (24%) of the audits were considered to be of a quality that could improve health care. We present recommendations to improve the audit procedure and foster the growing confidence among doctors in the medical audit.

Canada↗
PubMed1998

[A method for auditing medical records quality: audit of 467 medical records within the framework of the medical information systems project quality control].

Future hospital accreditation could take into account the quality of medical files. The objectives of this study is to test a method for auditing and evaluating the quality of the handing of medical files. We conducted a retrospective regional audit based on the frame of reference the National Agency for Medical Development and Evaluation, by using a sample of cases, stratified by establishment. In our region, the global budgets of 47 public and private hospitals participating in the public hospital service, are adjusted while keeping in mind the medicalised activity data (PMSI). This audit was proposed to the doctors of the Department of Medical Information on the occasion of the regulatory PMSI quality control. A total of 467 questionnaires were given by 39 of the 47 sollicited hospitals (83%). The methodological aspects (questionnaire, cooperative approach...) are discussed. The make-up of medical files can alos be improved by raising the percentage of the presence of important data or documents such as the reason for admission (74.1%), the surgery report (83.2%), and the hospitalisation report (66.6%). A system for classifying the paraclinical results is shared and systematic throughout the service or hospital in only 73.2% of cases. The quality of the handing of medical files seems problematic in our hospitals and actions for improving the quality should be undertaken as a priority.

Accreditation↗
PubMedDate not supplied

[The quality of care in shoulder pain. A medical audit].

BACKGROUND: To evaluate the quality of hospital ambulatory care in non-surgical painful shoulder by auditing medical records using quality indicators. MATERIAL AND METHODS: We reviewed 245 medical records of non-surgical patients assisted for pain shoulder in 1999-2000 in two public hospitals. Quality of care indicators for antecedents, physic exploration, diagnosis and treatment were developed based in systematic reviews of clinical trials, guidelines and expert criteria. Medical records review was carried out by two rehabilitative doctors. Fulfilling of quality criteria and differences between hospitals was analyzed. RESULTS: 76.3% of the medical records did not fulfill > or = 4 of 10 quality criteria for antecedents, 61.6% did not fulfill > or = 3 of 10 criteria for physical exploration, and 7.7% did not have any diagnosis registered. 96.9% of the 98 patients with impingement syndrome did not complete the criteria of anti-inflammatory treatment or infiltration in the pre-established time, and up to 15.3% had not been proposed physiotherapy or programmed exercise in the 4 weeks after the diagnosis; 95.8% of the 24 patients with rotators cuff tears were not proposed for early surgical evaluation, and 86.7% of the 15 cases of adhesive capsulitis did not receive instructions to carry out programmed exercise in the proposed times. CONCLUSIONS: The audit revealed significant deficiencies in adherence to quality indicators in non-surgical pain shoulder. Part of these problems can be due to low medical records quality.

Humans↗
PubMed1995

Use of vitamin B-12 in Leicestershire practices: a single topic audit led by a medical audit advisory group.

OBJECTIVE: To encourage active participation of Leicestershire general practitioners and their staff in audit; to examine the use of vitamin B-12 injections and to achieve a more appropriate use. DESIGN: Implementation of an agreed audit protocol, with central analysis and feedback of anonymous and aggregated data by a medical audit advisory group. SETTING: All 147 Leicestershire practices. MAIN OUTCOME MEASURES: Participation in the complete audit cycle, comparison of actual use of vitamin B-12 injections with agreed criteria of use, and assessment of improvement in use. RESULTS: 264 general practitioners (55% of all doctors from 49% of all Leicestershire practices) completed both phases of the audit cycle, and 321 (67%) completed phase 1 only. Twenty four (16%) practices failed to participate from the outset, and a further 58 (35%) dropped out at various stages. Only 10 of the 37 singlehanded practices completed the audit, although 34 initially agreed to participate. If singlehanded practices were excluded, 56% (61) of practices completed both phases of the audit cycle. In total 1714 patients received B-12 injections. Appropriate use increased from 62% in phase 1 to 72% in phase 2 of the audit; there was a 32% reduction in the number of patients inappropriately receiving B-12 (521 to 352), and the proportion of patients receiving B-12 at the correct frequency rose from 58% to 72%. The proportion of patients in whom all the diagnostic criteria for pernicious anaemia were established before treatment with B-12 was 27% in phase 1 and 28% in phase 2. CONCLUSION: Our study suggests that single topic audits organised by a medical audit advisory group can encourage large numbers of general practitioners to participate and can bring about changes in behaviour resulting in improvements in standards of care. Nevertheless, advisory groups will need to devise strategies to encourage even higher levels of involvement, most particularly from singlehanded practices.

Anemia, Pernicious↗
PubMed1994

Practice characteristics associated with audit activity: a medical audit advisory group survey.

AIM: A survey of general practices in West Glamorgan was carried out to assess the development of record systems and practice organization and to relate this to audit activity. METHOD: Following mutual agreement practices were visited by two assessors. Visits were conducted using an agreed protocol and practice data were recorded on a semi-structured questionnaire, which had been sent to the practices in advance of the visits. Practices varied from single handed practices to group practices with six partners. RESULTS: Fifty seven of the 63 practices in the county suitable for inclusion were visited (90%). Data were analysed from 54 practices (three visits were regarded as a pilot). The practices more likely to be involved in audit were those with three or more partners and which had modern medical record systems. Audit activity had occurred in 87% of practices who kept clinical summaries in the notes (compared with 38% who did not), in 87% of practices with long-term medication summaries in the notes (compared with 40% with no summaries) and in 85% of practices with a computerized age-sex register (compared with 50% with no register). All training practices had undertaken audit compared with 63% of non-training practices. CONCLUSION: The survey enabled the medical audit advisory group to identify the type and degree of audit undertaken locally and highlighted the characteristics which encourage this activity. As a consequence the group is able to target practices who have limited or no involvement in audit and to offer assistance and advice on record modification likely to enhance audit activity.

England↗
PubMed1995

The use of medical audit for producing guidelines of medical practice.

To demonstrate that Medical Audit can be used to produce guidelines for medical practice in an endeavour to ensure quality of medical care. The North Western Urological Audit Group meet regularly six monthly to audit their urological practice. Guidelines are drawn up taking in to account the recent published literature. Several adopted guidelines are presented together with three internationally suggested recommendations. The new competitive market for health care in the United Kingdom has necessitated the initiation of medical audit. Medical Audit has been used by the North Western Urological Audit Group to produce guidelines for medical practice to ensure quality of medical care. Medical Audit can be used to produce guidelines of medical care and ensure quality and uniformity of medical care.

England↗
PubMed1991

Auditing audits: the method of Oxfordshire Medical Audit Advisory Group.

OBJECTIVES: To develop a systematic method for both summative and formative audit of practice audits, and to use the method to review Oxfordshire practice audits and to plan improvement. DESIGN: Development of a coding system for the audit cycle subsequently used prospectively to assess audits reported to medical audit advisory group coordinators on practice visits. SETTING: All 85 general practices in Oxfordshire, of which 80 were visited by Oxfordshire Medical Audit Advisory Group coordinators. MAIN OUTCOME MEASURES: Satisfaction of criteria for different levels of audit (full, partial, potential, planning or no audit) according to coding scores for practice audits. RESULTS: 46 (58%) practices were classified as doing audit, the remainder doing no audit or only collecting data for family health services authority returns. Of audits being undertaken, 55/102 (54%) included planning care or the setting of targets. CONCLUSIONS: The coding system offers the prospect of formative assessment for practices to help them improve their audits, and summative assessment for the family health services authority to satisfy the needs for professional accountability. Its use in Oxfordshire disclosed considerable deficiencies in the process of practice audit. IMPLICATIONS AND ACTION: Practices in Oxfordshire should improve their audits. The advisory groups target to March 1992 is for 50% of practices to be doing full or partial and 25% potential audit and half of the remainder planning audit. Practices are encouraged to include in their audit implementing change, planning care, and agreeing criteria for further assessment.

England↗