The Quality Improvement Project MODULE 2: HOW TO DO A PRACTICE AUDIT? October 2015 Objectives 1. Explore how evidence based medicine can be applied at a patient and practice level 2. Learn how to complete a practice audit 3. Build confidence and competence to complete the practice audit component of the Quality Improvement Project October 2015 Resources: ePEARLS:Article: Eight steps to a Chart Audit for Quality. Fam Pract Manag Jul-Aug;15(7):A3-A8. October 2015 What is EBM to you? How does it relate to how you look after your individual patients? How does it relate to how you look after your whole practice? October 2015 Practice Audit: Three steps Step 1. Ask clinical question about how you are doing in the care of your patients. Step 2: Identify and appraise evidence for best practice Step 3. Complete Practice Audit to see how your practice is performing. Compare performance with best practice. Submit Practice Audit report October 2015 Step 1:Ask a clinical question. What bothers you? What scares you? Where are mistakes happening? What do you care passionately about? What is your clinic/organization working on? October 2015 Well built questions for a practice audit Clinical skills (e.g. How do I determine if a murmur suggestive of MVP is significant?) Therapeutic options (e.g. What is the most appropriate option for treating erectile dysfunction in young men?) New diagnostic tools/test (e.g. Should I start using a rapid assay test for Streptococcus in my office?) Communication skills (e.g. What is the best way to broach the subject of possible spousal abuse?) October 2015 Step 2: Find best practice or standard of care ASSESS the literature VALIDITY? IMPORTANCE? APPLICABLE TO YOUR POPULATION? October 2015 Step 3: Complete your Practice Audit. Defining your Practice Audit parameters IDENTIFY MEASURES: What data will you audit in chart/practice? ie: if breast cancer screening: mammograms in last yr? mammograms in last 2 years? Mammograms ordered? Mammograms done? Ie: if patient satisfaction with care: survey any patients in the practice? Survey only patients in waiting room? Ask about satisfaction? Ask if they felt understood? ) DEFINE POPULATION: Gender, age, disease status ie: if breast cancer screening: age 50-69? Seen at least once in last year? In last 3 years? DETERMINE SAMPLE SIZE: ideally charts/encounters/surveys randomly selected October 2015 Create an audit form October 2015 Article: Eight steps to a Chart Audit for Quality. Fam Pract Manag Jul-Aug;15(7):A3-A8. Step 3: Audit then Apply & Action AUDIT: Ideally charts/encounters/survey subjects What is your quality of care compared to target? Report main outcome as a simple % ie: only 10% of patient had required testing done APPLY/ACTION: How are you doing? What changes could you make? October 2015