Unregulated provider perceptions of audit and feedback reports in long-term care: cross-sectional survey findings from a quality improvement intervention.

BACKGROUND: Audit with feedback is a moderately effective approach for improving professional practice in other health care settings. Although unregulated caregivers give the majority of direct care in long-term care settings, little is known about how they understand and perceive feedback reports because unregulated providers have not been directly targeted to receive audit with feedback in quality improvement interventions in long-term care. The purpose of this paper is to describe unregulated care providers' perceptions of usefulness of a feedback report in four Canadian long-term care facilities. METHODS: We delivered monthly feedback reports to unregulated care providers for 13 months in 2009-2010. The feedback reports described a unit's performance in relation to falls, depression, and pain as compared to eight other units in the study. Follow-up surveys captured participant perceptions of the feedback report. We conducted descriptive analyses of the variables related to participant perceptions and multivariable logistic regression to assess the association between perceived usefulness of the feedback report and a set of independent variables. RESULTS: The vast majority (80%) of unregulated care providers (n = 171) who responded said they understood the reports. Those who discussed the report with others and were interested in other forms of data were more likely to find the feedback report useful for making changes in resident care. CONCLUSIONS: This work suggests that unregulated care providers can understand and feel positively about using audit with feedback reports to make changes to resident care. Further research should explore ways to promote fuller engagement of unregulated care providers in decision-making to improve quality of care in long-term care settings.

What do general practitioners think of the new professional competence scheme?

The Irish Medical Practitioners Act 2007 places a statutory obligation on all registered Medical Practitioners to maintain their professional competence by participating in a recognised Professional Competence Scheme. A questionnaire survey was conducted among 48 GPs attending educational meetings to see if doctors had concerns about the Professional Competence Scheme and to ask if they felt they had the necessary time, skills and knowledge to carry out an audit. Twenty-eight GPs (58%) had concerns regarding their participation in the Professional Competence Scheme; 75% were concerned about the time required, and 67% felt they needed further education about the scheme. Although 73% of doctors reported that they understand how to undertake a clinical audit and 50% reported they have carried out an audit in practice, 60% have never had any teaching on audit and 85% would like teaching in this area. Only 48% of the group surveyed felt that audit was practical in their current practice. Doctors have some concerns about the new Professional Competence Scheme, including the audit component. In particular, they report a requirement for more teaching in this area, and are concerned about the time involved.

[Petitioning for prosecution in the event of violation of the requirement to provide responsible health care]. / Påtalebegjæring ved brudd på kravet om forsvarlig helsehjelp.

BACKGROUND: The Norwegian Board of Health Supervision can petition for prosecution of health care personnel or facilities. The purpose of the survey is to find out what circumstances will prompt the Norwegian Board of Health Supervision to petition for prosecution of doctors and/or facilities for violation of the requirement of responsible conduct, how often this happens and what the outcome is. MATERIAL AND METHOD: Petitions for prosecution in the period 1 February 2002 - 31 October 2008 were reviewed. The data stem mainly from two databases containing about 11 500 cases brought before the Norwegian Board of Health Supervision. RESULTS: During the period, the Boards of Health Supervision at county level petitioned for prosecution in some 7,700 cases where doctors and/or facilities had failed to provide responsible health care. Unsound professional practice was found in about 2400 cases. The Board of Health Supervision petitioned for 19 prosecutions in 16 cases (0.7 %), in 9 of them against doctors and in 10 against facilities. Of the cases against doctors, four ended with fines, four were dismissed and in one a ruling has not yet been handed down. Eight facilities were fined, while the cases against two of them were dismissed. The number of petitions for prosecution has shown a declining tendency during the period. INTERPRETATION: The initiation of criminal proceedings against doctors and facilities is relegated by the Norwegian Board of Health Supervision to a minor position among its supervisory activities.

Medicaid Integrity Program; eligible entity and contracting requirements for the Medicaid Integrity audit program. Final rule.

Section 1936 of the Social Security Act (the Act) (as added by section 6034 of the Deficit Reduction Act of 2005 (DRA) established the Medicaid Integrity Program to promote the integrity of the Medicaid program by requiring CMS to enter into contracts with eligible entities to: (1) Review the actions of individuals or entities furnishing items or services (whether on a fee-for-service, risk, or other basis) for which payment may be made under an approved State plan and/or any waiver of such plan approved under section 1115 of the Act; (2) audit claims for payment of items or services furnished, or administrative services rendered, under a State plan; (3) identify overpayments to individuals or entities receiving Federal funds; and (4) educate providers of services, managed care entities, beneficiaries, and other individuals with respect to payment integrity and quality of care. This final rule will provide requirements for an eligible entity to enter into a contract under the Medicaid integrity audit program. The final rule will also establish the contracting requirements for eligible entities. The requirements will include procedures for identifying, evaluating, and resolving organizational conflicts of interest that are generally applicable to Federal acquisition and procurement; competitive procedures to be used; and procedures under which a contract may be renewed.

[Perinatal audit: the most important legal aspects]. / Perinatale audit: de belangrijkste juridische aspecten.

In The Netherlands a perinatal audit system is being prepared. Perinatal audit is seen as a powerful means of identifying substandard factors in perinatal care and of increasing the quality of care with better grounding. The proposed system does not raise insurmountable legal problems. However, certain legal aspects should be given specific attention. These aspects include the rights of patients with respect to privacy and information and the protection of health professionals against use of information from the audit system for reasons other than quality purposes. Legislation from other countries may inspire legislative developments in The Netherlands in this area.

A medicolegal analysis of malpractice claims involving anesthesiologists in the gastrointestinal endoscopy suite (2007-2016).

STUDY OBJECTIVE: Gastrointestinal endoscopy cases make up the largest portion of out of operating room malpractice claims involving anesthesiologists. To date, there has been no closed claims analysis specifically focusing on the claims from the endoscopy suite. We aim to identify associated case characteristics and contributing factors. DESIGN: Retrospective review of closed claims. SETTING: Multi-institutional setting of hospitals that submit data to the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System, a database representing approximately 30% of annual malpractice cases in the United States. PATIENTS: A total of 58 claims in the gastrointestinal endoscopy suite between January 1, 2007 and December 31, 2016. INTERVENTIONS: Gastrointestinal endoscopy procedures. MEASUREMENTS: We analyzed associated factors for each case as well as payments, and severity scores. MAIN RESULTS: There was a difference in the percent of cases that resulted in payment by procedure type, with 91% of endoscopic retrograde cholangiopancreatography (ERCP) cases resulting in payment compared with 37.5% of colonoscopy cases, 25% of combined esophagogastroduodenoscopy (EGD)/colonoscopy cases, 21.4% of EGD cases and 0.0% of endoscopic ultrasound cases (P = 0.0008). Oversedation was a possible contributing factor in 62.5% of cases. The mean payment for all claims involving anesthesiologists in the endoscopy suite was $99,754. CONCLUSIONS: There are differences in the rates of payment of malpractice claims between procedures. ERCPs made up a disproportionate percentage of the total amount paid to patients. While a significant percent of cases involved possible oversedation, these errors were compounded by other factors, such as failure to resuscitate or recognize the acute clinical change. With medically complex patients undergoing endoscopic procedures, it is critical to have well prepared anesthesia providers.

Auditing device clinical studies for US requirements.

Medical device manufacturers conducting clinical studies outside the United States (US) to support US regulatory submissions should be prepared to show that these studies are conducted in a manner that will be acceptable to the Food and Drug Administration. This article discusses the audits that can be conducted to assess this acceptability.

The Perth Emergency Laparotomy Audit.

BACKGROUND: Emergency laparotomies (ELs) are associated with high mortality and substantial outcome variation. There is no prospective Australian data on ELs. The aim of this study was to audit outcome after ELs in Western Australia. METHODS: A 12-week prospective audit was completed in 10 hospitals. Data collected included patient demographics, the clinical pathway, preoperative risk assessment and outcomes including 30-day mortality and length of stay. RESULTS: Data were recorded for 198 (76.2%) of 260 patients. The 30-day mortality was 6.5% (17/260) in participating hospitals, and 5.4% (19 of 354) across Western Australia. There was minimal variation between the three tertiary hospitals undertaking 220 of 354 (62.1%) ELs. The median and mean post-operative lengths of stay, excluding patients who died, were 8 and 10 days, respectively. In the 48 patients with a prospectively documented risk of ≥10%, both a consultant surgeon and anaesthetist were present for 68.8%, 62.8% were admitted to critical care and 45.8% commenced surgery within 2 h. The mortality in those retrospectively (62; 31%) and prospectively risk-assessed was 9.5% and 5.2%, respectively. CONCLUSION: This prospective EL audit demonstrated low 30-day mortality with little inter-hospital variation. Individual hospitals have scope to improve their standards of care. The importance of prospective risk assessment is clear.

Statistical sampling in a legislative framework for peer review of medicare services.

This article discusses problems addressed in developing an efficient way of identifying levels of inappropriate professional practice in delivery of Medicare services, using statistical sampling within a legislative peer-review scheme. An efficient alternative to the current sampling methodology is proposed.

Access to confidential medical records by courts and tribunals: the inapplicability of the doctrine of public interest immunity.

A number of Australian courts' decisions have afforded protection to public records. Statutory protection has also been given to counselling records in some jurisdictions in the context of the provision of services to victims of sexual assault. In the aftermath of the extension of public interest immunity in the particular circumstances of Clifford v Victorian Institute of Forensic Mental Health [1999] VSC 359, the argument was raised that a further extension should be made to protect personal health records against attempts at regulatory investigation of allegations of unprofessional conduct. In Royal Women's Hospital v Medical Practitioners Board (Vic) [2006] VSCA 85 the Victorian Court of Appeal unanimously declined to make such an extension. This appears to be indicative of a shift by Australian courts toward compelling disclosure of medical records in the interests of fairness save in very exceptional circumstances.

[Profile of a medical auditing group in the state of Rio Grande do Sul]. / Perfil dos médicos auditores no estado do Rio Grande do Sul.

BACKGROUND: This paper aims to determine the profile of the medical auditor in the State of Rio Grande do Sul, Brazil, based upon a group of physicians who participated in the post-graduation courses of Unimed Foundation Health Auditing, in the cities of Porto Alegre and Caxias do Sul, together with other professionals performing the same activity in the State of Rio Grande do Sul. METHODS: A historical review, a study of the laws and norms that guide the role of the Medical Auditor is presented as well as a review of the literature on medical auditing in Brazil. A non identifiable questionnaire was administered, where questions on personal data and professional training were made, as well as others related to personal satisfaction, health and well-being. RESULTS: The questionnaire was answered by 71 Medical Auditors, with a total of 85 positions in medical auditing at several workplaces. 83.8% are male, ages ranging from 41 to 50 years (38%), on the average they had been graduated for 21.96 +/- 7.68 years, performing medical auditing activities for 7.24 +/- 6.62 years and 88.7% hold a medical academic title and/or medical specialization courses in several areas. In the group researched, 25.37% are formally employed 60% are personally and professionally satisfied and are physically well. In the interviewed group, there are no physicians under 33 years of age nor any graduated for less than 7 years. CONCLUSIONS: A high level of medical education, specialization and updating is evident among the Medical Auditors that were interviewed. Data from the present study will contribute for the definition of the Brazilian Medical Auditor's Profile.