1,721,136 research outputs found
Impact of hospital and community provider based clinical audit programmes: perceptions of doctors, nurses and other health professionals
No full textA postal survey of staff (doctors, nurses, midwives, health visitors, therapy professionals, senior managers and clinical audit staff) was conducted in three English hospital and community healthcare providers. The aim was to assess staff perceptions of the impact of local clinical audit programmes and to investigate differences between staff groups. The questionnaire contained a 24 item opinion scale with a summary total: 371 out of 566 questionnaires were returned completed (66%). The majority of respondents were positive about the impact of clinical audit in their organizations, which is encouraging. However, there was a wide range of responses and significant variations between professional groups. Medical staff were significantly less positive than non-medics (p = 0.0007), and junior staff significantly less positive than seniors (p = 0.0306 for doctors and p = 0.0013 for other health care professions). After over five years experience of clinical audit in UK hospitals and community providers, many local staff remain sceptical about its real valu
Development of an instrument to assess staff perceptions of the impact of trust-based clinical audit programmes
No full textWe have developed and tested a questionnaire to assess staff perceptions of the impact of clinical audit within hospital and community trusts. The aim is to provide a tool for audit departments to assess the progress of their audit programmes, alongside other monitoring methods, and to identify perceived problems, and resistant or neglected groups of staff. Desirable attributes of audit programmes were identified through a qualitative analysis of policy documents from key national bodies. After pre?testing, 24 items were included in the questionnaire, along with an overall question on the value of audit, and space for written comments and suggestions. The questionnaire was piloted with health professionals in three trusts in South Thames. 371 out of 566 (66%) questionnaires were returned completed. After omitting two items the scale showed good internal consistency. The scale also performed well against the three tests of validity. The survey showed interesting differences between staff groups in the trust
Links between clinical audit and contracting systems
No full textIn 1989, a programme of clinical audit was introduced throughout the UK National Health Service (NHS), in an attempt to improve care through the application of quality methodology to clinical issues. However, the role of clinical audit in the new NHS "internal market" is unclear. Reviews evidence on the development of audit and concludes that it has operated largely in isolation, under professional control. Central policy is now advocating greater purchaser and provider management involvement in audit, enabling feedback from and to service provision and management decisions. Where there are constructive local relationships the opening up of audit should be beneficial, but these do not always exist. Discusses a range of models for the interaction of clinical audit with wider NHS management systems. Recommends a split system of professionally controlled background audit and collaborative shared audits to balance conflicting goals
Clinical audit and the purchaser-provider interaction: different attitudes and expectations in the United Kingdom
No full text
Evaluating healthcare policies: the case of clinical audit
No full textSince the introduction of national programmes of clinical audit in Britain much effort has gone into evaluating them. Many observational studies, both quantitative and qualitative, have been conducted, but when these provide evidence of changes in clinical practice or outcomes it is not possible to attribute these to audit. No controlled trials of the introduction of whole programmes of audit into healthcare organisations have been conducted and it is too late to conduct one now. Several trials of selected audit interventions in Britain and elsewhere have been performed, but their results are not easily generalisable to mainstream audit activity. We still do not know and will almost certainly never know, the scale of benefits or the true costs of the British national audit programmes. Evaluative research is worth while in indicating the types of audit activity and the types of audit organisation that are most likely to bring about chang
Evidence-based decision making: when should we wait for more information?
No full textWe discuss the challenge of managing innovation in and access to health care interventions in an evidence-based, cost-effective way, and we describe a decision-making framework (using U.S. and U.K. case studies) for health care payers considering the adoption of new technologies. We argue that providing reimbursement for what could be a cost-effective technology "only in the context of research" will be appropriate if the costs of delaying implementation are offset by the value of "keeping one's options open" by waiting for more information. We conclude that there is a need for better integration of health care decision-making processes with research policies
Economic evaluation of a primary care-based education programme for patients with osteo-arthritis of the knee
Full text linkThis study is an economic evaluation of a general practice-based nurse-led education programme for patients with osteoarthritis of the knee. The OAK study failed to demonstrate improvements in knowledge, self-efficacy in arthritis management, or health outcomes after 1 year. Not only were the differences not statistically significant, they were not consistent in direction. The cost analysis showed a highly significant increase in costs for the patients randomised to receive the education programme. There was no evidence that the costs of the educational intervention were offset by reduced utilisation of other health services during the period of follow-up. This evidence lends support to contention that general practice-based patient education programmes for knee osteoarthritis are not a cost-effective use of healthcare resources. However further evidence is required before this can be confirmed
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