Abstract
OBJECTIVE--To estimate the effects of medical audit, particularly setting clinical standards, on patients' health. DESIGN--Before and after study strengthened by a replicated Latin square. SETTING--62 training general practices in the north of England. PATIENTS--Random sample of 9000 children with any of five conditions--acute cough, acute vomiting, bedwetting, itchy rash, and recurrent wheezy chest--stratified by doctor consulted, condition, and age. INTERVENTIONS--Clinical standard set by each of 10 small groups comprising 84 general practitioner trainers for one randomly selected childhood condition. Each group also experienced a different type of medical audit, randomly selected, for each of the four other study conditions (receiving a clinical standard set by another trainer group, tabulated data comparing clinical performance with that of all other groups, tabulated data from only their own group, and nothing ("control" condition)). MAIN OUTCOME MEASURES--Condition specific, functional, psychological, and educational outcomes; together with parent satisfaction (recorded by home interviews and postal questionnaires). RESULTS--Children consulting trainers for recurrent wheezy chest after those doctors had set a standard for that condition improved both in drug compliance (79% (n = 33) before standard setting v 93% (30) after) and mean number of days of breathlessness (3.8 (SE 1.0) before v 1.7 (0.6) after) and wheeziness (4.7 (0.9) before v 1.8 (0.6) after), compared with those consulting doctors who had not (compliance 74% (144) before v 72% (146) after; breathlessness 2.4 (0.4) before v 2.3 (0.3) after; wheeziness 3.0 (0.4) before v 2.7 (0.4) after). There were no other significant effects of standard setting or audit on patients' health. CONCLUSION--Setting clinical standards improved drug compliance and respiratory function in children with recurrent wheezy chest.
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- Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1966 Jul;44(3 Suppl):166–206. [PubMed] [Google Scholar]
- Haynes R. B., Davis D. A., McKibbon A., Tugwell P. A critical appraisal of the efficacy of continuing medical education. JAMA. 1984 Jan 6;251(1):61–64. [PubMed] [Google Scholar]
- Mugford M., Banfield P., O'Hanlon M. Effects of feedback of information on clinical practice: a review. BMJ. 1991 Aug 17;303(6799):398–402. doi: 10.1136/bmj.303.6799.398. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Speight A. N., Lee D. A., Hey E. N. Underdiagnosis and undertreatment of asthma in childhood. Br Med J (Clin Res Ed) 1983 Apr 16;286(6373):1253–1256. doi: 10.1136/bmj.286.6373.1253. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Weiss G. L. Patient satisfaction with primary medical care. Evaluation of sociodemographic and predispositional factors. Med Care. 1988 Apr;26(4):383–392. doi: 10.1097/00005650-198804000-00007. [DOI] [PubMed] [Google Scholar]
- Zastowny T. R., Roghmann K. J., Hengst A. Satisfaction with medical care: replications and theoretic reevaluation. Med Care. 1983 Mar;21(3):294–322. doi: 10.1097/00005650-198303000-00004. [DOI] [PubMed] [Google Scholar]