Khunti K, Baker R, Rumsey M, Lakhani M
Eli Lilly National Clinical Audit Centre, Department of General Practice and Primary Health Care, University of Leicester, UK.
Int J Qual Health Care. 1999 Jun;11(3):221-6. doi: 10.1093/intqhc/11.3.221.
To investigate the approaches taken by audit groups in primary care in organizing multi-practice audits and to identify the strengths and weaknesses of the methods used.
Postal questionnaire survey.
One hundred and six primary care audit groups in England and Wales.
Ninety multi-practice audits had been conducted since 1993, 46 of which were audits of diabetes and 44 of asthma care. A total of 48 completed questionnaires (24 each for asthma and diabetes) were returned (response rate 53%). Audit groups reported inviting 3338 practices to take part, of which 1157 completed the audit. The commonest methods used to encourage practice participation were a personal letter (75%), audit group newsletter (63%) and sending an audit protocol to the practice (63%). Groups used various methods for selecting audit review criteria, however only three (6%) used a systematic review of available literature. Each audit group advocated a number of methods for identifying patients and for data extraction. Forty-one (85.6%) groups reported that practices received feedback of results in an individualized practice feedback report. In 19 (39.6%) audits, the audit group had not undertaken any follow-up.
The findings indicate that multi-practice audit can encourage the participation of large numbers of practices. Audit groups are co-ordinating multi-practice audits and feeding back information to practices on a comparative basis. However, there are weaknesses in the design and conduct of some audits. Groups should pay more attention to the selection of audit criteria, methods of identifying and sampling patients, data collection procedures, and methods for implementing changes in performance. For other countries that are beginning quality improvement activities, the results of this study emphasize the need to give attention to basic methodological principles.
调查基层医疗中的审核小组在组织多机构审核时所采用的方法，并确定所用方法的优缺点。
邮政问卷调查。
英格兰和威尔士的106个基层医疗审核小组。
自1993年以来共进行了90次多机构审核，其中46次是糖尿病审核，44次是哮喘护理审核。共收回48份完整问卷（哮喘和糖尿病各24份）（回复率53%）。审核小组报告称邀请了3338家机构参与，其中1157家完成了审核。鼓励机构参与的最常用方法是个人信件（75%）、审核小组时事通讯（63%）以及向机构发送审核方案（63%）。各小组采用了多种方法来选择审核标准，但只有三个小组（6%）对现有文献进行了系统回顾。每个审核小组都主张采用多种方法来识别患者和提取数据。41个小组（85.6%）报告称，机构收到了个性化机构反馈报告中的结果反馈。在19次审核（39.6%）中，审核小组未进行任何跟进。
研究结果表明，多机构审核能够鼓励大量机构参与。审核小组正在协调多机构审核，并在比较的基础上向机构反馈信息。然而，一些审核在设计和实施方面存在不足。各小组应更加关注审核标准的选择、识别和抽样患者的方法、数据收集程序以及绩效改进的实施方法。对于其他正在开展质量改进活动的国家，本研究结果强调了关注基本方法原则的必要性。
