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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

Medical audit now.

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Medical Audit

Introducing quality assurance and medical audit into the UCSF medical center curriculum.

The experience gained by a medical school faculty in developing and piloting a course for undergraduate medical students in medical care evaluation led to a similar effort for house staff. It is recognized that if the profession is to fulfill the demand by society for social accountability in the use of resources for health care, medical care assessment and quality assurance mechanisms must become an intimate part of the clinical experience of medical students and house officers. Teaching these subjects requires a theoretical framework; introduction of content and skills appropriate to the level of the student and continuation of progressively more advanced training throughout medical education; use of assessment and quality assurance techniques by clinician-teachers themselves to provide models for the student; and continued evolution of pedagogic approach and course content based on developments in the area.

California

A medical audit of acute alcoholism and chronic alcoholism.

A medical audit for acute alcoholism was done in a large private general hospital where the cases are admitted to and treated on the general medical service. Another medical audit was done for chronic alcoholism for patients admitted to an alcoholism rehabilitation unit in a large general hospital in a teaching center.

Alcoholic Intoxication

Orphan data and the unclosed loop: a dilemma in PSRO and medical audit.

The experience of the Utah Professional Review Organization in conducting medical audit as a PSRO prototype, and later a PSRO, suggests that usage of diagnosis-oriented process audits, using criteria similar to those supplied by the American Medical Association, will result in accumulation of vast amounts of unusable data. Even studies based on outcome data may fail to change physician behavior substantially because of communication difficulties between the PSRO or hospital conducting the evaluation and the physicians subject to the audit. UPRO's experience suggests that medical audit can be made more effective if it employs a special study format that looks at a particular element of care, selected for its importance to patient welfare and potential for improvement. The study should be based on criteria solidly validated by clinical research, and should involve a direct and personal interaction between the review body and the physician being reviewed.

Education, Medical, Continuing

The effects of mandatory quality assurance: a review of hospital medical audit processes.

A study of 17 hospitals in the Greater Delaware Valley region was undertaken in order to determine if those hospitals which had participated in an early voluntary effort to initiate medical audit differed qualitatively or quantitatively from a matched group of hospitals which had not participated in the previous project. The study also provided the opportunity to analyze the current status of medical audit in a group of hospitals which varied significantly in size, location, and educational responsibilities. Data regarding audit administrative organization, number of audits performed, type of system used, quality of audit criteria, and utilization of audit findings were gathered and analyzed. For these variables, no discernible differences were found between hospitals which had participated in the early voluntary project and those which had not. Wide variations were found among the hospitals in the extent to which medical audit processes were formalized and implemented. There were also variations in the quality of criteria formulated by the hospitals, but they generally did not receive a high rating. The implications of audit findings were generally not followed up in an organized and appropriate manner. Many hospitals which had received PSRO delegated status were given a low rating by the reviewers. The implications of these findings are discussed.

Education, Medical, Continuing

Drug therapy review as part of a medical audit process.

A method of chart review that focuses on the role of drugs as both therapeutic and iatrogenic agents in the sum of health care given to a patient is presented. A team of 11 to 16 health care professionals evaluated ambulatory health care systems funded by HEW. All clinician evaluators participated in the medical audit segment of the evaluation. Drug therapy review was based on an assessment of the relationship between patient, drug and other factors. Discussed also are the nine assessment options open to the evaluator and the mechanisms used to incorporate findings into the larger system review process. A by-product of the use of this process was increased prescribed-pharmacist cooperation and contribution in performance of the medical audit.

Ambulatory Care

Comparing medical audits: correlation, scaling, and sensitivity.

A modified Payne process and the JCAH intermediate outcome medical audits were applied to 6,980 cases in eight diagnostic categories within 22 hospitals, representing 1,321 attending physicians. Overall correlations between the two audits differed substantially from diagnosis to diagnosis, allowing for generally inconsistent and conflicting results when applied to a specific research question. Methods are illustrated for comparing the relative scaling (harshness) and sensitivity (discriminating power) of these two audit methods. The effects of the specificity of items, total number of items, outcome versus process indicators, and weights of items on the measurement characteristics of the audit methods are also discussed.

Hospitals

Conceptual framework for drug usage review, medical audit and other patient care review procedures.

The following concepts are discussed: (1) quality assurance programs, (2) drug usage review, (3) utilization review, (4) peer review, (5) medical audit, (6) patient care audit and (7) medical care evaluation studies. A framework within which all types of hospital quality assurance mechanisms can be constructed is proposed and their interrelationships are described. The pharmacist's particpiation in the hospital's overall quality assurance program is stressed in two main areas-drug usage review, performed jointly with the medical staff, and quality assurance of pharmaceutical services, a peer review function of the pharmacy profession. These services are primarily drug distribution and control, drug information, clinical pharmacy, continuing education, and other pharmacy and pharmacist functions. Both functions may be viewed as parts of the pharmacy audit, one of several patient care audits within the facility. Pharmacists in skilled nursing facilities have quality assurance responsibilities similar to those of hospital-based pharmacists.

Drug Utilization

The use of medical audits in surgical education.

Quality of medical care audits conducted in the form of a conference attended by surgical residents, faculty, and medical students accomplish the following: (1) provide an excellent educational experience for all participants; (2) are enthusiastically received by all concerned; (3) accomplish considerably more than audits performed in the manner prescribed by the Joint Commission on Accreditation of Hospitals (JCAH); and (4) fulfill JCAH/Professional Standards Review Organization (PSRO) requirements. This modified type of audit can be used successfully as a variant of a teaching seminar in which learning is more predictable because of the active participation of all concerned. Criteria sets which include simple and complex criteria must be developed if audits are to alter patterns of care for complex surgical problems.

Education, Medical, Graduate

Medical audit in British hospital practice.

The imposition of a rigid system of medical audit throughout the NHS would be inappropriate at this time; nevertheless, every hospital and general practice could usefully consider what informal methods of audit should be employed. Most hospitals should try weekly death and complication meetings in addition to their other postgraduate activities. Greater attention is required to ensure that the medical records are improved in both hospital and general practice. Metcalf's (1979) suggestion for auditing GP work seems feasible. As medicine becomes more complicated in terms of techniques and team activities there is a greater need for more systematic methods of defining and measuring standards of care and feeding back this information. Much more research is needed to determine whether process or outcome studies are preferable, and structure and patient risks must be taken into account. Whatever system is devised the medical profession will accept it provided it is fair, educational, and shown to benefit the patient.

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Medical audit.

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Medical Audit

Medical audit.

Explore the source record for details and available documents.

Medical Audit