Discussions of quality assurance mechanisms for health professions are increasing in Canada. In their roles of protecting the public from incompetent or unsafe health care, and enhancing the quality of care provided by practitioners, provincial licensing organizations are taking an interest in quality assurance programmes. The paper reports the results from a national survey of five self-regulating health professions (dentistry, medicine, nursing, optometry and pharmacy) in Canada. The study found two types of activities in place--a complaints programme and a routine audit programme. Both programmes use a similar approach to identifying poor performers within a health profession. The paper discusses the results of the study, the advantages and disadvantages of the approach used, and suggests a second approach to quality assurance which could be used in conjunction with current activities.
To determine the prevalence and types of medical quality assurance practices in Ontario hospitals.
All teaching, community, chronic care, rehabilitation and psychiatric hospitals that were members of the Ontario Hospital Association as of May 1990.
The person deemed by the chief executive officer of each hospital to be most responsible for medical administration.
A questionnaire to obtain information on each hospital's use of criteria audit, indicators inventory, occurrence screening and reporting, and utilization review and management (URM) activities.
Prevalence of the use of the quality assurance activities, the people responsible for the activities and the relative success of the URM program in modifying physicians' performance.
Of the 245 member hospitals participants from 179 (73%) responded. Criteria audits were performed in 136 (76%), indicators inventory in 43 (24%), occurrence screening in 44 (25%), occurrence reporting in 61 (34%) and URM in 123 (69%). In-hospital deaths were reviewed in 157 (88%) of the hospitals. In all, 87 (55%) of the respondents from hospitals that had a URM program or were developing one indicated that their program was successful in modifying physicians' practices, and 29 (18%) reported that it was not successful; 26 (16%) stated that the effect was still unknown, and 16 (10%) did not respond. Seventy (40%) stated that results of tissue reviews were reported at least 10 times per year and 94 (83%) that medical record reviews were reported at least as often. The differences in the prevalence of the quality assurance activities between the hospitals were not found to be significant.
Many Ontario hospitals are conducting a wide variety of quality assurance activities. Further study is required to determine whether the differences in prevalence of these activities between hospitals would be significant in a larger, perhaps national, sample. Strategies are needed to ensure universal involvement and participation in the improvement of the quality of care and the assessment of the cost-effectiveness of health care treatments. Recommendations to achieve these objectives are suggested.
Cites: CMAJ. 1990 Nov 15;143(10):1025-302224668
Cites: Qual Assur Health Care. 1990;2(1):13-92103868
Cites: N Engl J Med. 1989 Jan 5;320(1):53-62909878
Comment In: CMAJ. 1992 Aug 1;147(3):287, 2901643591
The goals were (1) to describe rates of diabetes mellitus (DM)-related hospitalizations and retinopathy screening before and after transition to adult care and (2) to test whether different methods of transfer of care were associated with improved outcomes.
In a retrospective cohort study, we included 1507 young adults with DM of >or=5-year duration and tracked these patients until 20 years of age.
DM-related hospitalization rates increased from 7.6 to 9.5 cases per 100 patient-years in the 2 years after transition to adult care (P = .03). Previous DM-related hospitalizations, lower income, female gender, and living in areas with low physician supply were associated with higher admission rates. With controlling for all other factors, individuals who were transferred to a new allied health care team with no change in physician were 23% less likely (relative risk: 0.23 [95% confidence interval: 0.05-0.79]) to be hospitalized after the transition than were those transferred to a new physician with either a new or no allied health care team. The rates of eye examinations were stable across the transition to adult care (72% vs 70%; P = .06). Female patients, patients with higher income, and patients with previous eye care were more likely to have an eye care visit after transfer.
During the transition to adult health care, there is increased risk of DM-related hospitalizations, although this may be attenuated in youths for whom there is physician continuity. Eye care visits were not related to transition; however, rates were below evidence-based guideline recommendations.