Department of Health Care Management and Policy, Surrey University, Guildford, UK Department of Health Sciences, University of Leicester, Leicester, UK.
Int J Clin Pract. 2012 Sep;66(9):874-82. doi: 10.1111/j.1742-1241.2012.02979.x. Epub 2012 Jul 12.
To conduct a service evaluation of usability and utility on-line clinical audit tools developed as part of a UK Classification of Diabetes project to improve the categorisation and ultimately management of diabetes.
We conducted the evaluation in eight volunteer computerised practices all achieving maximum pay-for-performance (P4P) indicators for diabetes; two allowed direct observation and videotaping of the process of running the on-line audit. We also reported the utility of the searches and the national levels of uptake.
Once launched 4235 unique visitors accessed the download pages in the first 3 months. We had feedback about problems from 10 practices, 7 were human error. Clinical audit naive staff ran the audits satisfactorily. However, they would prefer more explanation and more user-familiar tools built into their practice computerised medical record system. They wanted the people misdiagnosed and misclassified flagged and to be convinced miscoding mattered. People with T2DM misclassified as T1DM tended to be older (mean 62 vs. 47 years old). People misdiagnosed as having T2DM have apparently 'excellent' glycaemic control mean HbA1c 5.3% (34 mmol/mol) vs. 7.2% (55 mmol/mol) (p<0.001). People with vague codes not included in the P4P register (miscoded) have worse glycaemic control [HbA1c 8.1% (65 mmol/mol) SEM=0.42 vs.7.0% (53mmol/mol) SEM=0.11, p=0.006].
There was scope to improve diabetes management in practice achieving quality targets. Apparently 'excellent' glycaemic control may imply misdiagnosis, while miscoding is associated with worse control. On-line clinical audit toolkits provide a rapid method of dissemination and should be added to the armamentarium of quality improvement interventions.
对英国糖尿病分类项目中开发的在线临床审计工具的可用性和实用性进行评估，以改善糖尿病的分类，最终改善其管理。
我们在 8 家志愿使用计算机的诊所进行了评估，这些诊所均实现了糖尿病最高的按绩效付费（P4P）指标；其中两家允许直接观察和记录在线审计的过程。我们还报告了搜索的实用性和全国使用率。
在头 3 个月，有 4235 位唯一访客访问了下载页面。我们从 10 家诊所收到了有关问题的反馈，其中 7 例是人为错误。临床审计新手工作人员能够顺利运行审计，但他们希望在他们的实践计算机化医疗记录系统中增加更多的解释和更熟悉用户的工具。他们希望标记出被误诊和分类错误的患者，并使他们相信编码错误很重要。被错误诊断为 1 型糖尿病的 2 型糖尿病患者年龄较大（平均 62 岁比 47 岁）。被误诊为患有 2 型糖尿病的患者显然具有“极好”的血糖控制水平，平均糖化血红蛋白（HbA1c）为 5.3%（34mmol/mol），而 7.2%（55mmol/mol）（p<0.001）。未包括在 P4P 登记册中的模糊代码（编码错误）患者的血糖控制较差[糖化血红蛋白（HbA1c）8.1%（65mmol/mol）SEM=0.42 与 7.0%（53mmol/mol）SEM=0.11，p=0.006]。
在实践中，有改善糖尿病管理以实现质量目标的空间。显然“极好”的血糖控制可能意味着误诊，而编码错误与控制效果更差相关。在线临床审计工具包提供了一种快速传播的方法，应作为质量改进干预措施的补充手段。
