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Introduction: The Physician Enhancement Program (PEP) is an in-practice monitoring program for physicians with potential dyscompetency issues. One component of PEP is a monthly chart audit. The purpose of our study was to determine if physicians' charting skills improve through their participation in PEP. Methods: The sample included physicians who participated in PEP for at least 6 months regardless of specialization, age, or gender (n = 77). PEP chart audits evaluate seven different aspects of chart and care quality, including legibility, organization, history, assessment/formulation, treatment, physical examination, and overall chart quality. Each aspect of charting is scored on a Likert-type scale from a score of 1 to 9. We conducted pair-matched t tests of the mean item scores for the 1st versus 6th, 12th, 18th, and 24th month in PEP for all chart elements except legibility. We also compared the size of the paired differences by month 1 scores for overall chart quality mean score to determine if the magnitude of change varied by starting point. Results: There was significant improvement (P <.002) across the 6 chart quality elements per physician at months 6, 12, 18, and 24. Physicians who started below Q1 for overall chart quality mean showed most improvement, whereas those who started above Q3 had insignificant change as they had little room to improve. Discussion: PEP participants demonstrated improved charting skills for each chart quality element evaluated. PEP is an effective form of physician education resulting in physician behavior changes, especially for those physicians who need it the most. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the current study was to provide a contemporary review of electroconvulsive therapy (ECT) practice in Far North Queensland, Australia.Method: Demographic, diagnostic and treatment characteristics were extracted from the hospital files of people who received ECT between 2011 and 2013. Data were quantitatively analysed and described.Results: Depressive illnesses were the most common indicator for treatment. However, psychotic illnesses also made up a large proportion of treated cases. The technical aspects of treatment were commensurate with previous Australian findings except for the higher incidence of bifrontal ECT and maintenance treatment.Conclusions: Further research is needed across Australia to determine whether the findings of the current study represent changes in Australian ECT practice. [ABSTRACT FROM AUTHOR]

Background: The National Health and Family Planning Commission of China has issued more than 400 clinical pathways to improve the effectiveness and efficiency of medical care delivered by public hospitals in China. The aim of our study is to determine whether patient care is compliant with national clinical pathways in public general hospitals of Pudong New Area in Shanghai.Methods: We identified the clinical pathways established by the National Health and Family Planning Commission of China for 5 common conditions (community-acquired pneumonia, acute myocardial infarction (AMI), heart failure, cesarean section, type-2 diabetes). We randomly selected patients with each condition admitted to one of 7 public general hospitals in Pudong New Area in China in January, 2013. We identified key process indicators (KPIs) for each pathway and, based on chart review for each patient, determined whether the patient's care was compliant for each indicator. We calculated the proportion of care which was compliant with clinical pathways for each indicator, the average proportion of indicators that were met for each patient, and the proportion of patients whose care was compliant for all measures. For selected indicators, we compared compliance rates among hospitals in our study with those from other countries.Results: Average compliance rates across the KPIs for each condition ranged from 61 % for AMI to 89 % for pneumonia. The percent of patient receiving fully compliant care ranged from 0 for AMI and heart failure to 39 % for pneumonia. Compared to the compliance rate for process indicators in the hospitals of other countries, some rates in the hospitals that we audited were higher, but some were lower.Conclusions: Few patients received care that complied with all the pathways for each condition. The reasons for low compliance with national clinical pathways and how to improve clinical quality in public hospitals of China need to be further explored. [ABSTRACT FROM AUTHOR]

Background: Medical Records Reviews (MRR) are commonly used in research and quality activities in health care, however, there is a paucity of literature offering a step by step guide to devising a reliable, user-friendly tool. Aim: This instructional paper focuses on the stages used to design and implement successful MRR using examples from two reviews in Australian rural hospitals investigating the responses of Registered Nurses to patient deterioration, and guided by time series principals. Methods: The MRR were conducted in two rural hospitals in conjunction with a simulation learning intervention where nurses rehearsed clinical management of a deteriorating patient. A six-step template is presented to guide practitioners on how to design and use a MRR tool. Conclusion: When well-planned and appropriately used, MRR provides an excellent means for examining patient outcomes in addition to safety and quality of care. [ABSTRACT FROM AUTHOR]

Background: Cancer survivors have cancer surveillance and preventive screening needs that require monitoring. Little is known regarding their patterns of care in community primary care practices.Methods: Secondary analysis of 750 baseline patient surveys and medical record audits for patients ages 50+ years in 25 community-based primary care practices (N = 109 survivors and 641 noncancer patients).Results: Patient self-reported screening rates for breast cancer (72%), colorectal cancer (81%) and prostate cancer (77%) were higher for cancer survivors compared to noncancer patients (69%, 67%, 53%, respectively). Screening rates documented in the primary care records were lower for all cancers. Cancer survivors were more likely than others to report having been screened for colorectal cancer (P = 0.002) even after excluding colorectal cancer survivors from the analysis (P = 0.034). Male cancer survivors were more likely to report being screened for prostate cancer than those without cancer (P < 0.001), even after excluding prostate cancer survivors (P = 0.020). There were no significant differences in either self-reported or medical record report of breast cancer screening rates among cancer survivors and noncancer patients.Conclusions: Cancer survivors were more likely to self-report receipt of cancer screening than noncancer patients. Medical record reports of cancer screening were lower than self-reports for cancer survivors and noncancer patients. Identifying factors that affect cancer screening among cancer survivors is important and has implications for intervention design. [ABSTRACT FROM AUTHOR]

Abstract: Background: Few interventions to increase colorectal cancer screening have used a stage of change model to promote screening adoption. None have used computer-assisted tailored telephone counseling calls. This study''s purpose was to implement and evaluate stage-based computer-assisted tailored telephone counseling to promote colorectal cancer screening in a primary care population. Methods: This randomized controlled trial used a two-stepped intervention that included a mailed booklet on colorectal cancer screening followed by computer-assisted telephone counseling that was based on the Precaution Adoption Process Model. Chart audit was used to document completion of colonoscopy, sigmoidoscopy or fecal occult blood testing. Results: Record audits were completed on 2474 (88%) of the 2817 eligible participants. There was no significant difference in the frequency and nature of the screening tests completed in the study arms. In a sub-analysis, stages of adoption were evaluated pre- and post-telephone counseling. Over half those receiving counseling reported a change in stage towards screening adoption. Conclusion: Overall, the intervention did not increase colorectal screening compared to control. Two possible reasons for the absence of a screening effect include: (a) the focus of the protocol on education for most patients rather than motivation, and (b) the requirement that patients interested in screening seek further information and a referral on their own from their providers. While those receiving telephone counseling improved their stage of adoption, we cannot rule out selection bias. Stronger physician recommendation to speak with the counselors could improve call acceptance. Future colorectal screening should address these weaknesses. [Copyright &y& Elsevier]

Abstract: Background: Thorough follow-up of a positive fecal occult blood test (FOBT) result, or a complete diagnostic evaluation (CDE), is recommended as routine care on the basis of findings from colorectal cancer (CRC) screening trials. CDE involves either colonoscopy or the combination of flexible sigmoidoscopy and double contrast barium enema X-ray. However, little evidence outside clinical screening trial settings has been reported in the literature to support CDE performance. The focus of this study was to determine the impact of CDE in primary care practice settings. Methods: We determined diagnostic outcomes for 461 adult patients with a positive FOBT result in 318 primary care practices in southeastern Pennsylvania and southern New Jersey. Sociodemographic data were collected and CDE status was ascertained for these patients. Polytomous logistic models were used to identify whether having CDE was associated with subsequently being diagnosed with lower gastrointestinal “neoplastic disease” or “other gastrointestinal disease” as compared to “normal findings.”Results: Patients who underwent CDE were significantly more likely to have a reported diagnosis of colorectal neoplasia than normal findings (adjusted odds ratio=3.65, 95% confidence interval=1.58–8.39, p =0.02). CDE performance did not result in the differential diagnosis of other gastrointestinal disease. Conclusions: Patients with a positive screening FOBT who underwent CDE were more likely to be diagnosed with colorectal neoplasia than with less serious conditions or have normal findings. Results support the use of CDE in CRC screening. [Copyright &y& Elsevier]

Radiation oncology charts containing medical information and treatment details are the major methods of communication between the various personnel involved in delivering radiation therapy to the patient. It is paramount to good patient care for this communication to be clear, precise and accurate in detail. A regular chart audit should be a part of the quality assurance programme of every radiation oncology department. The primary aim of this study was to develop and assess an objective and quantitative programme for reviewing radiation oncology charts, thereby improving the quality of communication and hence patient management. A secondary aim was to compare the charts of radically treated patients with those treated palliatively. A pilot study using a new chart review tool, developed at the Perth Radiation Oncology Centre, was carried out over an 8-month period. A sample of charts, representing 25% of our treatment group, were assessed using the tool on a monthly basis. A total of 156 charts were reviewed during this time period. Fifty-six per cent were radical treatments and 44% were palliative. The overall mean chart scores significantly improved over the time of this study ( P < 0.001). The individual radiation oncologists’ scores were also seen to improve during the study period. The alpha coefficients for intra-rater and inter-rater reliability were 0.99 and 0.88, respectively. The chart review programme was found to be an easy-to-use and a reliable tool by both medical and non-medical reviewers. It appeared to have a positive influence on the standard of radiation oncology charts in our department. [ABSTRACT FROM AUTHOR]

Evidence exists that some dentists may be failing to perform adequate periodontal diagnostic and preventive care for their patients. Continuing education (CE) is an avenue that is frequently employed as a strategy to alter the style of practice. This paper presents an evaluation of a year-long continuing education intervention "Periodontics in General Practice", conducted among randomly selected private general dental practices in Adelaide, South Australia. The CE intervention featured a 1-day seminar, bi-monthly newsletters, individualised 3-monthly comparative feedback, and technical assistance. The study employed a longitudinal quasi- experimental design, which allowed for evaluation of the effectiveness of the intervention among practices employing hygienists (n = 12) and not employing dental hygienists (n = 12), taking into account the covariates of baseline level of provision of periodontal services, the practice's level of participation in the intervention and attendance at other CE courses in periodontics over the year. A comparison group of practice (n = 12) did not participate in the intervention over the year. Patient record audits. conducted at baseline and at 12 months, provided data for the evaluation of the effect of the intervention on the recording of periodontal diagnostic, preventive and treatment items. Practices participating in the intervention showed increases in the percentage of records containing at least one periodontal diagnostic notation, and those practices employing hygienists showed an increase in the percentage of records with at least one preventive notation and one treatment item. The results indicate that an extended continuing education intervention can have significant effect on the provision of periodontal services. and that the magnitude of the effect differs between practices employing and not employing hygienists. [ABSTRACT FROM AUTHOR]

The article presents a study conducted by the authors related to the use of chart audits for evaluating effect of quality improvement (QI)-based continuing medical education (CME) on adherence to rheumatoid arthritis (RA) quality measures by rheumatologists. Topics discussed include an increase in adherence rate in posteducation group, baseline rates and posteducation not different for disease-modifying antirheumatic drug (DMARD) therapy prescription and positive patient outcome with adherence.

The article discusses the development of quality improvement (QI) program to assess influence of continuing education on gastroenterologists' adherence to quality measures and practice guidelines to treat patients with ulcerative colitis (UC). Topics discussed include the program's 4 phases including physician recruitment and chart selection, baseline chart audit and educational intervention and the need for continuing education to support gastroenterologists to improve quality measures for UC.