Improving Quality in an Internal Medicine Residency Program Through a Peer Medical Record Audit
This study examined the effectiveness of a quality improvement project of a limited didactic session, a medical record audit by peers, and casual feedback within a residency program.
Residents audited their peers' medical records from the clinic of a university hospital in March, April, August, and September 2007. A 24-item quality-of-care score was developed for five common diagnoses, expressed from 0 to 100, with 100 as complete compliance. Audit scores were compared by month and experience of the resident as an auditor.
A total of 469 medical records, audited by 12 residents, for 80 clinic residents, were included. The mean quality-of-care score was 89 (95% CI = 88-91); the scores in March, April, August, and September were 88 (95% CI = 85-91), 94 (95% CI = 90-96), 87 (95% CI = 85-89), and 91 (95% CI = 89-93), respectively. The mean score of 58 records of residents who had experience as auditors was 94 (95% CI = 89-96) compared with 89 (95% CI = 87-90) for those who did not. The score significantly varied (P = .0009) from March to April and from April to August, but it was not significantly associated with experience as an auditor with multivariate analysis.
Residents' compliance with the standards of care was generally high. Residents responded to the project well, but their performance dropped after a break in the intervention. Continuation of the audit process may be necessary for a sustained effect on quality.
Available from: Colleen Y. Colbert
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ABSTRACT: A changing health care environment has created a need for physicians trained in health system improvement. Residency programs have struggled to teach and assess practice-based learning and improvement and systems-based practice competencies, particularly within ambulatory settings.
We describe a resident-created and resident-led quality and practice-improvement council in an internal medicine continuity clinic. We conducted focus groups and report on residents' perspectives on council membership, practice management experiences, quality improvement projects, and resident satisfaction.
Focus groups were held from May 2009 to March 2010 with internal medicine residents (N = 5/focus group) who participated in the Continuity Clinic Ownership in Resident Education (CCORE) council. Data were analyzed with a grounded theory approach.
DURING THE FOCUS GROUPS, RESIDENTS RESPONDED TO THE QUESTION: "Do you have any new insights into delivering quality patient care in an outpatient clinic as a result of this experience (CCORE membership)?" The qualitative analysis resulted in 6 themes: systems thinking and systems-based care skills; improving quality of patient care; improved clinic efficiency; ownership of patients; need for improved communication of practice changes; and a springboard for research.
CCORE residents participated in system changes and acquired leadership skills while working on practice-based and system problems in a clinic microsystem. We believe this model can be implemented by other residency programs to promote the development of systems thinking in residents, increase their ownership of continuity clinic, and empower them to implement system changes.
06/2012; 4(2):232-6. DOI:10.4300/JGME-D-11-00133.1
Available from: ult.sagepub.com
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ABSTRACT: Assessment of diagnostic image quality in gynaecological ultrasound is an important aspect of imaging department quality assurance. This may be addressed through audit, but who should undertake the audit, what should be measured and how, remains contentious. The aim of this study was to identify whether peer audit is a suitable method of assessing the diagnostic quality of gynaecological ultrasound images. Nineteen gynaecological ultrasound studies were independently assessed by six sonographers utilising a pilot version of an audit tool. Outcome measures were levels of inter-rater agreement using different data collection methods (binary scores, Likert scale, continuous scale), effect of ultrasound study difficulty on study score and whether systematic differences were present between reviewers of different clinical grades and length of experience. Inter-rater agreement ranged from moderate to good depending on the data collection method. A continuous scale gave the highest level of inter-rater agreement with an intra-class correlation coefficient of 0.73. A strong correlation (r = 0.89) between study difficulty and study score was yielded. Length of clinical experience between reviewers had no effect on the audit scores, but individuals of a higher clinical grade gave significantly lower scores than those of a lower grade (p = 0.04). Peer audit is a promising tool in the assessment of ultrasound image quality. Continuous scales seem to be the best method of data collection implying a strong element of heuristically driven decision making by reviewing ultrasound practitioners.
Ultrasound 02/2013; 22(1):44-51. DOI:10.1177/1742271X13511242
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ABSTRACT: Expanding clinical teaching opportunities is essential for securing a sustainable health workforce. Although Tasmanian general practitioners (GPs) are keen to provide learning opportunities for medical students, they have identifed time pressures due to a need to meet patient service demand and a need for more guidance on effective clinical teaching, as factors impacting their ability to increase clinical supervision. By developing a clinical audit activity, we delivered an educational resource that did not require direct GP supervision yet provided meaningful learning outcomes for students. Through systematically reviewing patient records it was hoped that students would strengthen practicebased quality improvement activities, thus 'giving back' to their placement practice.
A clinical audit curriculum was developed for fourth-year medical students at the Launceston Clinical School (n = 46) and implemented during their general practice rotation. This included a lecture and tutorial, and structured activities based on an audit of diabetes care. Preparation and support was provided to GP supervisors and practice staff through ongoing practice visits conducted by school academics. Implementation of the curriculum within general practice was evaluated through focus groups conducted with staff from five training practices (n = 29). Evaluation of student experiences is ongoing.
This paper reports on the experiences of general practice supervisors and other practice staff. GPs and practice staff responded positively, indicating that the syllabus provided novel teaching opportunities and a modest contribution to improving patient records and patient care. Major learning opportunities identified included the development of skills working with patient records and practice software, and understanding the importance of accurate and reliable medical records for the optimal delivery of patient care.
Conducting clinical audit provides students with novel learning opportunities while also strengthening the capacity of teaching general practices to provide clinical placements. Students learnt about the importance of monitoring professional practice using systematic clinical audit, and the complexities of managing patients within primary care. In so doing, they enhanced the robustness and rigor of patient records within their placement practice.
Quality in primary care 02/2014; 22(1):35-41.
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