Increasing Clinical Prevention Efforts in a Family Practice Residency Program Through CQI Methods
| Autor: | Mark Gottlieb, Loren A. Leshan, Mark Fitzsimmons, Anne M. Marbella |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Medical Audit
medicine.medical_specialty Quality management Total quality management medicine.diagnostic_test business.industry MEDLINE Internship and Residency Sigmoidoscopy General Medicine Checklist Wisconsin Documentation Nursing Family medicine Practice Guidelines as Topic Preventive Health Services medicine Humans Family Practice Remedial education business Total Quality Management Tertiary Prevention |
| Zdroj: | The Joint Commission Journal on Quality Improvement. 23:391-400 |
| ISSN: | 1070-3241 |
| Popis: | Article-at-a-Glance Background As primary care physicians develop ongoing relationships with their patients, each contact provides another opportunity for primary, secondary, or tertiary prevention activities. In 1991 an interdisciplinary prevention project team using continuous quality improvement (CQI) principles was established to improve family practice residents' provision of such services. Diagnostic journey For a random sample of 60 patient charts, abstractors looked for documentation of 23 clinical preventive services, including nursing screens, physician on-site and off-site implemented services, lifestyle education (diet, tobacco use), and self-screening education. After the chart review, the physicians, nurses, residents, and clinical staff used a fishbone analysis to identify physician-, clinic system–, and patient-centered factors contributing to the lack of conformance with clinical prevention guidelines. Remedial journey The residency program began a series of didactic sessions on clinical prevention and instituted a procedures rotation to teach prevention procedure skills such as flexible sigmoidoscopy, stress testing, and colposcopy. On the CQI team's recommendation, a checklist developed by physicians and staff which itemized age- and gender-specific clinical prevention services was placed at the front of all patient charts. Clinic-system and patient factors were also addressed. Holding the gains—monitoring performance The 1993 postintervention chart review showed significant improvements for 17 (81%) of the 21 targeted services. Discussion Providing educational sessions on prevention, permitting residents to select the areas of prevention on which to focus, and giving feedback on resident and staff performance through ongoing, nonpunitive monitoring resulted in increased provision of clinical prevention services in a family practice residency training center. |
| Databáze: | OpenAIRE |
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