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 compare postreferral waiting times to hospital in internal medicine with the urgency of the cases as assessed by a panel of doctors.
Retrospective evaluation of referrals to three hospitals during 1 week.
Referrals to internal medicine departments of Kuopio University Hospital, Kajaani central hospital and Pieksämäki regional hospital in Finland.
Two specialists in internal medicine working in university hospital and four specialists in general practice, two of whom were private sector general practitioners (GPs), the other two being public health centre chief physicians.
Postreferral waiting times, assessment of the urgency of the referral by a panel of doctors, and the reliability of this assessment.
Mean delay to specialist consultation was 36 days. There were no significant differences between the assessors in their opinions regarding the degree of urgency of referrals. Interobserver agreement between assessors was moderate or substantial (kappa values 0.46-0.62) and intraobserver agreement varied from moderate to almost perfect (kappa values were between 0.57 and 0.88). However, of those patients who were assessed to require examination by a consultant within 1 week only 34% actually saw the specialist within that time. Of those patients who were assessed to be require the treatments within 8-30 days, 48% were examined by a specialist within that time.
It is possible to reliably assess the urgency of referrals to internal medicine departments. There is a need to improve the referral process for those patients requiring consultation with a hospital specialist within 30 days.
Many aspects of medicine would be well served by a simple method to assess the outcome of care in specified groups of patients. This study examined charts of patients with stomach cancer on a surgical service. Two digits were added to the ICD-9 number in the routine discharge data; one for the nature and severity of case and the other for the outcome of care. The digits were designed for on-line registration at discharge. Information was also obtained on resource consumption in the various groups of patients. Most of the variables had to be evaluated implicitly as there were no explicit judgement criteria and few empiric data available for comparison. Implicit evaluation of the results was significant and prompted steps for improving care. With current systems, the information obtained from traditional hospital statistics is limited and partly misleading. By slight modification, however, hospital statistics may provide valuable information for assessing quality of care and resource allocation during hospitalization.