Bowie Paul, Cooke Sarah, Lo Penny, McKay John, Lough Murray
NHS Education for Scotland, Glasgow, UK.
J Eval Clin Pract. 2007 Jun;13(3):352-7. doi: 10.1111/j.1365-2753.2006.00704.x.
Clinical audit has failed to fully deliver the rewards initially envisaged. Contributory factors include: an ill-defined approach to audit; the assumption that health care professionals can intuitively apply audit methods; and the lack of a system to 'quality assure' the process. A method of criterion audit was defined and developed in conjunction with an instrument to facilitate trained General Practitioner (GP) assessors in the review of colleagues' audit projects. Given the potential for improving audit practice, this study aimed to define the methodological factors that contributed to 'unsatisfactory' audits as judged by peer assessors.
West of Scotland GPs voluntarily submitted a criterion audit in a standard format for review by two trained colleagues using an assessment instrument. Audits judged unsatisfactory and associated educational feedback were subjected to content analysis.
Between 1999 and 2004, 336 audits were submitted, of which 132 (39%) were judged to be unsatisfactory. Of these, 118 audits (89%) had a methodological issue identified in the initial project design (e.g. defining criteria) that effectively invalidated the audit. 119 projects (90%) were also judged to have at least one deficiency in the data analysis or change management stages of the audit (e.g. implementing inadequate change).
A range of audit method issues was found. The proportion of unsatisfactory audits may point to a larger problem beyond this sample, which may have implications for health care quality. If audit practise is to be consistent and rigorous, consideration should be given to assessing the standard of this activity.
临床审计未能充分实现最初设想的回报。促成因素包括：审计方法定义不明确；认为医疗保健专业人员能够直观地应用审计方法；以及缺乏对该过程进行“质量保证”的系统。结合一种工具定义并开发了一种标准审计方法，以帮助经过培训的全科医生（GP）评估人员审查同事的审计项目。鉴于改进审计实践的潜力，本研究旨在确定被同行评估者判定为“不令人满意”的审计中所涉及的方法学因素。
苏格兰西部的全科医生自愿以标准格式提交一份标准审计，由两名经过培训的同事使用评估工具进行审查。对被判定为不令人满意的审计及相关教育反馈进行内容分析。
在1999年至2004年期间，共提交了336份审计，其中132份（39%）被判定为不令人满意。在这些审计中，118份（89%）在初始项目设计（如定义标准）中存在方法学问题，这实际上使审计无效。119个项目（90%）在审计的数据分析或变更管理阶段也被判定至少存在一个缺陷（如实施的变更不足）。
发现了一系列审计方法问题。不令人满意的审计比例可能表明该样本之外存在更大的问题，这可能对医疗质量产生影响。如果审计实践要保持一致和严谨，应考虑评估这项活动的标准。
