Grant R L, Batty G M, Aggarwal R, Lowe D, Potter J M, Pearson M G, Oborne A, Jackson S H D
Clinical Effectiveness and Evaluation Unit, The Royal College of Physicians of London, UK.
J Eval Clin Pract. 2002 May;8(2):189-98. doi: 10.1046/j.1365-2753.2002.00309.x.
RATIONALE, AIMS AND OBJECTIVES: This national clinical audit aimed to develop and implement a methodology to assess the appropriateness of prescribing for patients over the age of 65 in hospitals, general practice and nursing homes.
Organizations providing health care in the National Health Service in these three sectors were recruited into multi-disciplinary and inter-organizational local coalition teams. Prescription data and relevant clinical data were collected electronically on a customized database. The appropriateness of prescribing for specific conditions among the patients sampled was assessed by simple computerized algorithms, and users were provided with feedback to stimulate discussion and change. Use of the software tool was demonstrated to be feasible and its data reliable. Participants were re-audited, after a period of nationally guided and locally driven intervention, to evaluate levels of change. Local efforts to stimulate change and barriers to change were collected qualitatively.
The investigation revealed encouraging results and demonstrated the ability of audit to improve the quality of clinical services in given circumstances, although a multiplicity of questions relating to cost and methodology remain to be addressed.
原理、目的和目标：这项全国性临床审计旨在开发并实施一种方法，以评估医院、全科医疗及疗养院中65岁以上患者的处方开具是否恰当。
在这三个领域为国民医疗服务体系提供医疗服务的机构被纳入多学科、跨组织的地方联合团队。通过定制数据库以电子方式收集处方数据和相关临床数据。通过简单的计算机算法评估抽样患者中特定病症的处方开具是否恰当，并向用户提供反馈以促进讨论和改进。软件工具的使用被证明是可行的，其数据可靠。在经过一段时间的全国指导和地方推动的干预后，对参与者进行重新审计，以评估变化程度。定性收集地方促进变革的努力和变革障碍。
调查结果令人鼓舞，表明审计有能力在特定情况下提高临床服务质量，尽管与成本和方法相关的诸多问题仍有待解决。
