Mayefsky J H, Foye H R
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, New York.
Med Educ. 1993 Mar;27(2):170-4. doi: 10.1111/j.1365-2923.1993.tb00248.x.
A prospective study employing a randomly assigned control group was conducted to assess the usefulness of a chart audit in teaching paediatric residents the components of well child care. The charts of children less than 5 years of age were reviewed and compared with audit criteria. Per cent compliance scores were calculated for five categories: present history; behaviour-development; family history; past medical history; and physical assessment. Five separate audits (10 charts per resident per audit) were conducted--two prior to giving the residents feedback, one after informing them that a study was being conducted, once a month after giving feedback, and one a year later. There was no significant difference between the baseline scores of the two groups. In addition, there were no significant changes in the experimental group's scores during the first three audits or the control group's scores over the whole 3-year course of the study. However, one month after receiving feedback, the scores of the experimental group improved significantly in present history, behaviour-development, and past history. One year later, the experimental group's scores were lower in every category than in the preceding audit. However, their scores were higher than the control group and the difference reached statistical significance in present history. We conclude that regular chart audits with feedback are a valuable addition to the primary care curriculum in a paediatric residency programme.
一项采用随机分配对照组的前瞻性研究开展，以评估图表审核在教导儿科住院医师儿童健康保健组成部分方面的效用。对5岁以下儿童的病历进行审查，并与审核标准进行比较。计算了五个类别的合规百分比得分：现病史；行为发育；家族史；既往病史；以及体格检查。进行了五次单独的审核（每次审核每位住院医师10份病历）——两次在向住院医师提供反馈之前，一次在告知他们正在进行一项研究之后，在提供反馈后每月一次，以及一年后一次。两组的基线得分之间没有显著差异。此外，在头三次审核期间，实验组的得分或在整个3年研究过程中对照组的得分均没有显著变化。然而，在收到反馈一个月后，实验组在现病史、行为发育和既往病史方面的得分显著提高。一年后，实验组在每个类别中的得分均低于前一次审核。然而，他们的得分高于对照组，并且在现病史方面差异达到统计学显著性。我们得出结论，有反馈的定期图表审核是儿科住院医师培训项目初级保健课程中一项有价值的补充。
