The Effect of Problem-Oriented Medical Records on Clinical Management Controlled for Patient Risks

Lc, Fernow; Mackie, Craig; McColl, Ian; Rendall, Max

doi:10.1097/00005650-197806000-00004

Cited by 15 publications

(1 citation statement)

References 15 publications

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“…However, adoption of a ‘norm’ as a standard may often not be successful in leading to a change in practice as many clinicians will rightly attribute variation in their own practice from the ‘norm’ to differences in the nature and severity of illness experienced in their patients. As Fernow et al (1978) have pointed out, patient variation should be considered when developing standards for audit. Thus, in the assessment of outcome, separate standards may have to be set for different groups of patients; in the assessment of process, a standard composed of criteria in an algorithmic form (as previously described) may be the most appropriate.…”

Section: Setting a Standard Of Practicementioning

confidence: 99%

Medical audit cycle

Fowkes

1982

Medical Education

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1. Summary The aim of medical audit is to improve the effectiveness and efficiency of medical care. Achieving this aim may involve a cycle of activities: (i) observing practice; (ii) setting a standard of practice; (iii) comparing the observed practice with the standard; (iv) implementing change; and (v) re‐observing practice. This paper reviews those methods which have been used and tested in clinical practice at the various stages of the cycle. Some principles involved in the choice of what to audit are also described. As definitive cost effective methods of auditing have not yet emerged, further initiatives and experimentation are required in clinical practice.

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Section: Setting a Standard Of Practicementioning

confidence: 99%

Medical audit cycle

Fowkes

1982

Medical Education

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Changing clinical practice: Which interventions work?

Tamblyn

Battista

1993

Journal of Continuing Education in the Health Professions

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Changing clinical practice is a complex challenge. A framework is presented for integrating the perspectives of continuing education, technology assessment, and quality assurance. The effectiveness of cwrent interventions is reviewed. We describe what is known about practice determinants, the most important of which are physician age, clinical training, knowledge, skill, personal characteristics, practice setting, arid reimbursement policies. The rehtive importance of these factors varies and seems to be condition-specif c, an important point to be considered in the selection of pi-actice interventions.Interventions aimed at having an impact on the practice setting (e.g., practice aids or audit programs), 01-on reimbursement policy (e.g., the fee allowed for a service) are more likely to bring about a change in practice than are interventions aimed at changing physician knowledge or skill. This is attributed to the greater relevance of these interventionsfor the individual physician, and to the opportunities provided for practicing them and for feedback. The cost and .feasibility of using the various types cf interventions to bring about practice change hmte to be carefully Haighed against the expected benefit f o r patients. Those seeking to select strategies that will optimize the effectiveness of interventions will need to consider the relative importance of physician abilities and attitudes, pi-actice harriers, and economic disincentives to practice change.

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