1. The Quality Improvement Project MODULE 2: HOW TO DO A PRACTICE AUDIT? October 2015

2. Objectives 1. Explore how evidence based medicine can be applied at a patient and practice level 2. Learn how to complete a practice audit 3. Build confidence and competence to complete the practice audit component of the Quality Improvement Project October 2015

3. Resources: “ePEARLS”: http://www.cfpc.ca/Pearls_for_Residents/http://www.cfpc.ca/Pearls_for_Residents/ Article: Eight steps to a Chart Audit for Quality. Fam Pract Manag. 2008 Jul-Aug;15(7):A3-A8. October 2015

4. What is EBM to you?  How does it relate to how you look after your individual patients?  How does it relate to how you look after your whole practice? October 2015

5. Practice Audit: Three steps  Step 1. Ask clinical question about how you are doing in the care of your patients.  Step 2: Identify and appraise evidence for best practice  Step 3. Complete Practice Audit to see how your practice is performing. Compare performance with best practice. Submit Practice Audit report October 2015

6. Step 1:Ask a clinical question…. What bothers you? What scares you? Where are mistakes happening? What do you care passionately about? What is your clinic/organization working on? October 2015

7. “ Well built” questions for a practice audit  Clinical skills (e.g. How do I determine if a murmur suggestive of MVP is significant?)  Therapeutic options (e.g. What is the most appropriate option for treating erectile dysfunction in young men?)  New diagnostic tools/test (e.g. Should I start using a rapid assay test for Streptococcus in my office?)  Communication skills (e.g. What is the best way to broach the subject of possible spousal abuse?) October 2015

8. Step 2: Find “best practice” or “standard of care” ASSESS the literature VALIDITY? IMPORTANCE? APPLICABLE TO YOUR POPULATION? October 2015

9. Step 3: Complete your Practice Audit. Defining your Practice Audit parameters IDENTIFY MEASURES: What data will you audit in chart/practice? ie: if breast cancer screening: mammograms in last yr? mammograms in last 2 years? Mammograms ordered? Mammograms done? Ie: if patient satisfaction with care: survey any patients in the practice? Survey only patients in waiting room? Ask about satisfaction? Ask if they felt understood? ) DEFINE POPULATION: Gender, age, disease status ie: if breast cancer screening: age 50-69? Seen at least once in last year? In last 3 years? DETERMINE SAMPLE SIZE: ideally 15-20 charts/encounters/surveys randomly selected October 2015

10. Create an audit form October 2015 Article: Eight steps to a Chart Audit for Quality. Fam Pract Manag. 2008 Jul-Aug;15(7):A3-A8.

11. Step 3: Audit then Apply & Action AUDIT: Ideally 15-20 charts/encounters/survey subjects What is your quality of care compared to target? Report main outcome as a simple % ie: only 10% of patient had required testing done APPLY/ACTION: How are you doing? What changes could you make? October 2015