Gagliardi Anna R, Brouwers Melissa C, Finelli Antonio, Campbell Craig M, Marlow Bernard A, Silver Ivan L
CIHR New Investigator in Knowledge Translation, University of Toronto, Department of Surgery and Health Policy, Canada.
J Contin Educ Health Prof. 2011 Fall;31(4):258-64. doi: 10.1002/chp.20138.
Self-audit involves self-collection of personal performance data, reflection on gaps between performance and standards, and development and implementation of learning or quality improvement plans by individual care providers. It appears to stimulate learning and quality improvement, but few physicians engage in self-audit. The purpose of this study was to identify how self-audit has been operationalized; factors influencing self-audit conduct and outcomes, including program design; and issues warranting further research.
A systematic review of quantitative and qualitative studies was undertaken. Two individuals independently reviewed searches of indexed literature databases, tables of contents, and references of eligible studies. Data were extracted and tabulated to describe the nature and impact of self-audit programs.
Six studies evaluated the impact of self-audit programs. No program was based on a model or theory that informed its design. All studies showed improved compliance with care delivery guidelines and/or improved patient outcomes, although these findings were largely self-reported. Programs varied so features associated with benefit could not be identified.
Overall there is a need for guidance on all aspects of self-audit for both participants and leaders. This guidance would be useful to educators, professional associations, and medical certification bodies to plan, develop, implement, evaluate, and support self-audit programs. Further research should aim at developing training programs and tools that address and evaluate a variety of competencies across different disciplines using more rigorous research designs, including both quantitative and qualitative approaches.
自我审核涉及个人绩效数据的自我收集、对绩效与标准之间差距的反思，以及个体医疗服务提供者制定并实施学习或质量改进计划。自我审核似乎能促进学习和质量改进，但很少有医生进行自我审核。本研究的目的是确定自我审核是如何实施的；影响自我审核实施及结果的因素，包括项目设计；以及值得进一步研究的问题。
对定量和定性研究进行了系统评价。两名研究人员独立检索了索引文献数据库、合格研究的目录和参考文献。提取数据并制成表格，以描述自我审核项目的性质和影响。
六项研究评估了自我审核项目的影响。没有一个项目是基于指导其设计的模型或理论。所有研究均显示，在遵循护理指南方面有所改善和/或患者预后有所改善，尽管这些结果大多是自我报告的。各项目差异较大，因此无法确定与效益相关的特征。
总体而言，需要为参与者和领导者提供关于自我审核各方面的指导。该指导对教育工作者、专业协会和医学认证机构规划、开发、实施、评估和支持自我审核项目将是有用的。进一步的研究应旨在开发培训项目和工具，使用更严谨的研究设计，包括定量和定性方法，来处理和评估不同学科的各种能力。
