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| Quality Assurance in General Practitioners (BE QUICK - Benchmarking Quality Assurance In Clinical Practice for Hong Kong) |
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Preventive Care Audit Manual |
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PDF download (Word download) |
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4. The Preventive Care Audit Instructions 4.1. The purpose of this audit is to help you assess how you are performing in the delivery of preventive care in your practice. There are two cycles of preventive activity that you have to complete and record. In each cycle you will need to record preventive data for 50 patient encounters (not patient numbers) within any period during the cycle. You then compare your preventive practice in the two cycles so that you can assess how you may have changed your practice of preventive care between two cycle periods. 4.2. In the first cycle you would have to enroll between the months of January and August of any calendar year. There is no restriction on the duration of each cycle but you must plan your audit so that the second audit cycle can be finished on time for assessment. Submit your summary and report for the first cycle as soon as possible. Read the guidelines for writing up and submitting your report in the following Section.5. 4.3. In the second cycle you repeat what you did in the first cycle. The interval between the close of the first cycle and the start of the second cycle must be at least two months to allow sufficient time for any changes to be implemented before the next cycle. You must complete your second cycle and submit your final report by 30th November to allow time for your assessment before the end of the CME/CPD year. 4.4. Recording the preventive activity 4.4.1. Firstly check the patient’s age and choose the Patient Data Form (PDF) corresponding to the age group of the patient. 4.4.2. There are 4 different Patient Data Forms (PDFs), one Form for each of the specific age groups Age 0-5 years Age 6-19 years Age 20-50 years Age over 50 years 4.4.3. In each PDF Form, there are 5 categories of activities listed. In each category there are recommended preventive activities. Category A is for Age Appropriate Screening Category B is for Behavioural Screening Category C is for Counseling Category D is for Diagnostic tests Category E is for Elective screening for a target condition These activities are checked for the evidence-based recommendations ranked from Ra to Rc (see Table 7.1). Under the category D, there are only a few tests that are recommended for general screening of asymptomatic individuals or individuals in the high risk group as these tests have to fulfill the screening criteria as stated in Section 2. 4.4.4. In each PDF there are ten patient encounter entries in vertical columns. 4.4.5. At the first patient encounter for your audit cycle, enter the date on the left top corner of the appropriate PDF. This is the Audit Starting Date of that particular audit cycle. Enter the same date on each of the PDF on subsequent patient encounters. The date of the last patient encounter (i.e. the 50th or later encounter in a particular audit cycle) is the Audit Closing Date of the audit cycle. Enter the date on the left top corner of the PDF just below the Staring Date. Also enter the same closing date on each of the other PDFs you have completed during the audit cycle. The Starting Date and the Closing Date should be the same in all PDFs for a particular audit cycle. You do not have to enter any other dates on the PDFs. The Starting & Closing dates are necessary to determine the duration of the audit cycle and to calculate the preventive care index. 4.4.6. Now, put a tick against the preventive activity (e.g. the blood pressure activity) on the PDF. You may perform more than one preventive activity for a patient on one encounter. For example besides the blood pressure you may counsel him on smoking, diet and exercises at the same time. You then put 4 ticks against the 4 activities in the one patient encounter column. These are the 4 preventive activities on one encounter. If you do other preventive activities on this same patient on a different day, you need to start him on a new patient encounter number with a new vertical column for that particular patient encounter. It is the 50 patient encounters, not the 50 individual patients that are required for each audit cycle. Each preventive activity item recorded gives you one point score regardless of when and for whom you have delivered the preventive care. 4.5 The preventive index Once you have completed the preventive activity on 50 patient encounters you then proceed to the calculations as follows. 4.5.1. Add the number of all preventive activities recorded on the PDFs for a particular age group to give a preventive score (X) for that age group 4.5.2. Add up the preventive scores (X’s) of ALL 4 age groups and say the number is Y 4.5.3. Find out the total patient encounters number (N) of your practice within the period of preventive care audit cycle from the Audit Starting Date to the Audit Closing Date recorded on the PDFs. This total patient encounter number can be retrieved from your patient registration/consultation record, your practice computer or be estimated to the best of your ability. 4.5.4. Y divided by N x 100% gives you the ‘preventive index’ - the percentage of preventive care per patient encounter in your whole practice within the period of the audit cycle. 4.5.5. Fill in the summary sheet and write your comments for the first cycle report in accordance with the guidelines below (See Section 5). 4.5.6. Repeat the same process for the second cycle after completing your preventive care exercises for 50 patient encounters (at least 2 months from the close of the first cycle). |