Abstract
Objectives:A quality improvement process that will significantly increase the rate of identification of psychosocial problems through routine use of case-finding instruments can be established in a general medicine practice.
Design:Two groups of patient examination reports written by physicians were retrospectively compared with the patients’ responses on the case-finding database instrument. The samples were obtained by sequential selection in four time periods.
Setting and Patients:The study occurred in a university general internal medicine practice that utilizes the problem-oriented record. The patients studied were seen for first-time comprehensive examinations designed to identify all important bealth problems, including psychosocial problems.
Intervention:The authors compared performances of the physicians in identification of psychosocial problems before and after the intervention, which consisted of a pilot study audit of psychosocial problem identification, establishment of standards for interpretation of the case-finding instrument, design of a flow sheet to make case-finding data clearly available to the physician at each comprebensive examination, and feedback of physician performance according to practice-adopted standards for identification of psychosocial problems.
Measurement:The result of the intervention was an increase in psychosocial problem identification from 67% to 90% of problems present, p<0.05 by chi-square distribution; or a decrease from 33% to 10% in psychosocial problems missed by the physicians.
Conclusion:The quality improvement process for identification of psychosocial problems described in this report significantly increased the rate of identification of psychosocial problems by general internists.
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Bingham, R.L., Plante, D.A., Bronson, D.L. et al. Establishing a quality improvement process for identification of psychosocial problems in a primary care practice. J Gen Intern Med 5, 342–346 (1990). https://doi.org/10.1007/BF02600403
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DOI: https://doi.org/10.1007/BF02600403