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Author FM

Last update 12/1/97

Working Definition

Hughes and Humphries (1990) King Edward's Hospital Fund

Summarised the essential features of GP audit as:
1. Defining standards, criteria, targets or protocols for good practice against which performance can be compared.
2. Systematic gathering of objective evidence about performance.
3. Comparing results against standards/peers
4. Identifying deficiencies and taking action to remedy them.
5. Monitoring the effects of action on quality.

Audit is a process more active than simply counting, there should be self improvement through standard setting , measurement, change and reassessment.

History

Donabedian (1966) proposed that the quality of health care can be regarded as comprising 3 interrelated parts called:

Structure: Physical attributes of health care
- surgery building, practice equipment,, record, staff

Process: What the GP actually does
- practice activity such as prescribing habits, hospital referrals, lab usage

Outcome: Changes in patients current and future health status that can be attributed to antecedent health care
- prevention of disease
-prevention of premature death
-patient satisfaction with care provided

Types of audit

1. Self audit: within the practice
Should be the foundation of any system of quality assurance that undergoes regular assessment and improvement. The practice team motivated to question and initiate change from within is most likely to provide best care and achieve the highest standards

2. Peer audit: Local, cheap and can act a source of new ideas
Can bring measured objectivity without being over threatening.

3. External audit: ? has a place in establishing minimal standards if incentives or sanctions are attached may result in improved standards

Choosing a subject

Any subject chosen should be seen by the practice team as:
1. Likely to benefit the patients
2. Likely to benefit the practice
3. Relevant to professional practice
4. Relevant to professional development
5. Significant in terms of the process and outcome of patient care.
6. Having potential for improvement
7. Capable of holding the interest and involvement of team members
8. Likely to repay the investment of time , money and effort involved

Planning the audit and the Audit Cycle
1. Define the nature of the problem
2. Statement of aims which must be unambiguous and capable of testing.
3. Agree ideal performance standards ( these may come from consensus statements s, results of formal clinical trials
4. Select most appropriate methods, which are influenced by the appropriateness and availability of local resources

Sources of data and sampling include:
a. routine practice data
b. external data (FHSA)
c. medical records
d. practice activity analysis
e. prospective recording of data
f. surveys
g. interviews
h. direct observation

5. Decide upon the basic design features, retrospective, prospective, sampling type
6. Identify the main analysis to be made
7. Who is involved, people are aware of their roles
8. Start small, proceed step by step over a short time scale
9. Indicate how the possible need for change is to be handled.

Steps 4-8 allow audit to be performed

THEN

A. Compare the outcome with performance criteria

B. Agree and implement change, to bring expected and actual performance together

C. Repeat audit and A & B until agreed standards are achieved

Cost/Benefits of Audit in GP

Benefits

1. May reduce frustration in GP, e.g. by improving procedures in GP
2. Bring about change
3. Reducing organisational and clinical error
4. Improving efficiency and effectiveness
5. Demonstrating good care
6. Meeting patients needs and expectations
7. Stimulating education
8. Promoting higher standards of community care
9. Bidding for resources
10. Securing effective medical defence through risk avoidance

Costs

Audit demands

1. Time and effort
2. Commitment may not be shared equally by different members of the team
3. A willingness to be inspected
4. a receptive attitude to constructive criticism and the flexibility to change.

 

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