Use of an outpatient medical record audit to achieve educational objectives
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Objective:To evaluate the effectiveness of a process whereby a faculty-resident committee annually audits outpatient record keeping and preventive care practices and provides feedback to resident physicians.
Design:Pre- and postfeedback audits with interventions and observations repeated over six consecutive academic years.
Setting:The adult primary care practice of housestaff in a university-affiliated hospital.
Subjects:All 139 physicians in an internal medicine residency program from 1981–82 through 1986–87, of whom 37 were present for three consecutive years.
Intervention:Each year, residents were given individualized, detailed, typewritten feedback based on audits of their outpatient records.
Measurements and main results:Each resident physician had a minimum of four (mean 5.2) outpatient records per year audited against standards for record-keeping practices and the provision of preventive care. Overall performance scores for each resident audit improved from a mean of 39.7±12.3 (SD) in 1981–82 to a mean of 58.5±14.1 (SD) in 1986–87 (possible range 0 to 100, observed range 9.4 to 86.6). The overall performance scores of individual residents, who received two cycles of feedback, improved an average of 11.5 (95% confidence limits 7.6, 15.3), from a mean of 48.4±11.4 (SD) during their first year of residency to 59.8±13.9 (SD) during their third year. General (primary care) and traditional-track residents improved at similar rates, although mean performance scores were consistently higher for general than for traditional-track residents. Analysis of variance revealed that all changes and differences were statistically significant.
Conclusions:An ongoing chart audit and feedback system can be associated with improvements both in the performance of individual residents and in the long-term performance of a residency program.
- Frame PC, Kowulich BA, Llewellyn AM. Improving physician compliance with a health maintenance protocol. J Fam Pract. 1984;19:341–4.
- Lau RR, Williams HS, Williams LC, Ware JE, Brook RH. Psychosocial problems in chronically ill children: physician concern, patient satisfaction, and the validity of medical records. J Comm Health. 1982;7:250–61. CrossRef
- Moran MT, Wiser TH, Nada J, Gross H. Measuring medical residents’ chart documentation practices. J Med Educ. 1988;63:860–5.
- Zuckerman AE, Starfield B, Hochreiter C, Kovasznay B. Validating the content of pediatric medical records by means of tape-recording doctor-patient encounters. Pediatrics. 1975;56:407–11.
- Brook RH, Fink A, Kosecoff J, et al. Educating physicians and treating patients in the ambulatory setting: where are we going and how will we know when we arrive? Ann Intern Med. 1987;107:392–8.
- Cheney C, Ramsdell JW. Effect of medical record checklists on implementation of periodic health measures. Am J Med. 1987;83:129–36. CrossRef
- Davidson RA, Fletcher SW, Retchins DVHS. A nurse-initiated reminder system for the periodic health examination. Arch Intern Med. 1984;144:2167–70. CrossRef
- Dietrich AJ, Goldberg H. Preventive content of adult primary care: do generalists and subspecialists differ? Am J Public Health. 1984;74:223–7.
- Fleming DM, Lawrence MSTA. Impact of audit on preventive measures. Br Med J. 1983;287:1852–4.
- Korn JE, Schlossberg LA, Rich EC. Improved preventive care following an intervention during an ambulatory care rotation: carryover to a second setting. J Gen Intern Med. 1988;3:156–60.
- Lurie N, Manning WG, Peterson C, Goldberg GA, Phelps CA, Lillard L. Preventive care: do we practice what we preach? Am J Public Health. 1987;77:801–4.
- McDonald CJ, Hui SL, Smith DM, et al. Reminders to physicians from an introspective computer medical record: a two-year randomized trial. Ann Intern Med. 1984;100:130–8.
- Davis JE, Meyer DL, Love RR. Cancer prevention activities in primary care group practice: physician estimates, physician performance, and the structure of practice. Submitted Med. Care.
- Tierney WM, Hui SL, McDonald CJ. Delayed feedback of physician performance versus immediate reminders to perform preventive care. Med Care. 1986;24:659–66. CrossRef
- Winickoff RN, Coltin K, Morgan MM, Buxbaum RC, Barnett GO. Improving physician performance through peer comparison feedback. Med Care. 1984;22:527–34. CrossRef
- Duggan AK. Analysis of the concordance between provider performance and recording [dissertation]. Baltimore, MD: The Johns Hopkins University, 1985.
- Schulman J, Wood C. Flow sheets for charts of ambulatory patients. JAMA. 1971;217:933–7. CrossRef
- Starfield B, Simborg D, Johns C, Horn S. Coordination of care and its relationship to continuity and medical records. Med Care. 1977;15:929–38. CrossRef
- Williamson J. Continuing education and patient care research: physician response to screening test results. JAMA. 1967;201:118–22. CrossRef
- Wooliscroft JO, Calhoon JG, Billiu GA, Beauchamp C. Medical student attention to preventive medicine: change with time and reinforcement. Am J Prev Med. 1988;4:166–71.
- Bouchard RE, Tufo HM, Beaty HN. The impact of a quality assurance program on postgraduate training in internal medicine. JAMA. 1985;253:1146–50. CrossRef
- Nelson GE, Graves SM, Holland RR, Nelson JM, Ratner J, Weed LL. A performance-based method of student evaluation. J Med Educ. 1976;10:33–42.
- Boekeloo B. Evaluation of strategies for increasing cholesterol management practices in inpatients [dissertation]. Baltimore, MD: The Johns Hopkins University, 1988.
- Kern DE, Grayson M, Barker LR, et al. Residency training in interviewing skills and the psychosocial domain of medical practice. J Gen Intern Med. 1989;4:421–31. CrossRef
- Whiting-O’Keefe QE, Henke C, Simborg DW. Choosing the correct unit of analysis in medical care experiments. Med Care. 1984;22:1101–13. CrossRef
- Linn BS. Continuing medical education: impact on emergency room burn care. JAMA. 1980;244:565–70. CrossRef
- Martin AR, Wolfe MA, Thibodeau LA, Dzau V, Braunwald E. A trial of two strategies to modify the test-ordering behavior of medical residents. N Engl J Med. 1980;303:1330–6. CrossRef
- Sanazaro PJ, Worth RM. Concurrent quality assurance in hospital care: report of a study by private initiative in PSRO. N Engl J Med. 1978;298:1171–7. CrossRef
- Bennett SE, Goodson JD, Izem E, et al. Comparing ambulatory care practices of primary care and traditional medicine residents. Med Care. 1985;23:816–22. CrossRef
- Ramsdell JW, Berry CC. Evaluation of general and traditional internal medicine residents utilizing a medical records audit based on educational objectives. Med Care. 1983;21:1144–53. CrossRef
- Makuc DM, Fried IM, Kleinman JC. National trends in the use of preventive health care by women. Am J Public Health. 1989;79:21–6. CrossRef
- Dickie GL, Bass MJ. Improving problem oriented medical records through self-audit. J Fam Pract. 1980;10:487–90.
- Barker LR, Starfield B, Gross RJ, Kern DE, Levine D, Fishelman P. Recognition of information and coordination of ambulatory care by medical residents. Med Care. 1989;27(5):558–62. CrossRef
- Pinkerton RE, Tinanoff N, Williams JL, Tapp JT. Resident physician performance in a continuing education format: does newly acquired knowledge improve patient care? JAMA. 1980;244:2183–5. CrossRef
- Goldenberg K. Periodic health examination: comparison of residency programs and national recommendations. J Gen Intern Med. 1986;1:282–6. CrossRef
- Use of an outpatient medical record audit to achieve educational objectives
Journal of General Internal Medicine
Volume 5, Issue 3 , pp 218-224
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- medical audit
- primary health care
- internship and residency
- medical records
- Industry Sectors
- Author Affiliations
- 1. the Department of Medicine, The Johns Hopkins University, School of Medicine, Francis Scott Key Medical Center, USA
- 3. the Department of Information Systems and Decision Sciences, Loyola College in Maryland, USA
- 4. the Department of Health Policy and Management, The Johns Hopkins University, School of Hygiene and Public Health (BOB), USA