PubMed · 12369339
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Philip M Renner. 2002. NCQA's evolving clinical performance measures.. https://pubmed.ncbi.nlm.nih.gov/12369339/
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This article describes the process of building and implementing a quality management system in the Department of Laboratory Medicine at St. Michael's Hospital in Toronto. This was done in part to fulfill the requirements of the Ontario Laboratory Accreditation program. During the process, we revised and created new procedure manuals and documents through the use of focus groups and inter-departmental committees. The entire project took approximately two-and-a-half years to complete and required teamwork, personal commitment, and professional sacrifices by key personnel.
PURPOSE: The external audit of oncologist clinical practice is increasingly important because of the incorporation of audits into national maintenance of certification (MOC) programs. However, there are few reports of external audits of oncology practice or decision making. Our institution (The Cancer Institute, Singapore) was asked to externally audit an oncology department in a developing Asian nation, providing a unique opportunity to explore the feasibility of such a process. METHODS AND MATERIALS: We audited 100 randomly selected patients simulated for radiotherapy in 2003, using a previously reported audit instrument assessing clinical documentation/quality assurance and medical decision making. RESULTS: Clinical documentation/quality assurance, decision making, and overall performance criteria were adequate 74.4%, 88.3%, and 80.2% of the time, respectively. Overall 52.0% of cases received suboptimal management. Multivariate analysis revealed palliative intent was associated with improved documentation/clinical quality assurance (p = 0.07), decision making (p = 0.007), overall performance (p = 0.003), and optimal treatment rates (p = 0.07); non-small-cell lung cancer or central nervous system primary sites were associated with better decision making (p = 0.001), overall performance (p = 0.03), and optimal treatment rates (p = 0.002). CONCLUSIONS: Despite the poor results, the external audit had several benefits. It identified learning needs for future targeting, and the auditor provided facilitating feedback to address systematic errors identified. Our experience was also helpful in refining our national revalidation audit instrument. The feasibility of the external audit supports the consideration of including audit in national MOC programs.
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