[Critical appraisal of articles about clinical audit]. / Klinikai auditról szóló közlemények kritikus elemzése.

OBJECTIVE: To summarize the most important criteria used in critical appraisal of publications about clinical audit by the review of the relevant English language literature. METHODS: Electronic databases, including Medline, Science Direct, and Ingenta Select, and Internet search were used to find relevant English language publication between 1985 and 2005. Hand search and the reference lists search for publications were also applied. In addition, researchers were also contacted for publications. RESULTS: The literature is surprisingly scarce about the critical appraisal of clinical audit publications. As a result hand search was as important as electronic search. The following three screening criteria can be used in order to critically appraise the scientific literature: (a) whether or not valid and relevant criteria and standards were used to evaluate clinical practice, (b) the criteria were used systematically on a representative sample of patients, and (c) the results are important and applicable (generalizable) in our practice. The publication is useful if it helps to improve the quality of our own clinical practice. CONCLUSION: Critical appraisal criteria can be used to improve the quality of clinical audit, and disseminate the results of audit, as well as find high quality evidence for designing and implementing quality improvement initiatives.

[Practice pattern and geographic variation in test ordering. A literature review]. / Külónbségek a vizsgálatok használatáinak gyakoriságában: irodalmi áttekintés.

OBJECTIVE: To review the available research results in order to identify evidence about geographical variation and practice variation in primary care in the diagnostic test ordering. METHODS: Electronic databases, Medline, Cochrane Library, Science Direct, and Ingenta Select were used to find relevant English language publication between 1989 and 2004. Hand search and the reference lists search for publications were also applied. In addition, researchers were also contacted for publications. Quality of the studies were assessed by using criteria such as sound description of research methodology, detailed and clear presentation of study results. RESULTS: There is a significant (2-4 fold) variation in laboratory test ordering between countries as well as between regions and praxis. There is larger (10-20 fold or more) variation between regions and praxis in the case of diagnostic tests which clinical usefulness is uncertain. The variation between diagnostic test ordering can be larger than variation between medical treatments or invasive interventions. Both geographical and praxis variation could be a result of multiple factors. None of the examined single factor alone was able to explain most of the variations. CONCLUSIONS: Variation in diagnostic test utilisation is significant, and could be caused by multiple factors. Optimisation of diagnostic test ordering and promotion of appropriate utilisation may require multifaceted intervention throughout the health system including changes in regulation, licensing, available capacity, reimbursement/incentive systems and continuous medical education as well as better patient information.

[The role of clinical audit in the quality improvement of health care]. / A klinikai audit szerepe az egészségügyi minoségfejlesztésben.

The aim of clinical audit is continuous improvement of the quality of care through systematic and critical review of current practice against explicit criteria and the implementation of change if necessary. The audit is a regular multidisciplinary activity by which all participants of care including doctors, nurses and other health professionals carry out a systematic review of their own practice. Data collected during the process of audit should be handled with care, and individual data concerning care-givers, patients or health professionals must be treated confidentially. Clinical audit needs realistic timeframe and necessary resources as well as tolerant culture of learning organisations. Furthermore the success of clinical audit depends on the commitment and support of the management of the organisations. Clinical audit could relatively easily be embodied into the current practice of peer-review processes and other quality improvement initiatives in Hungary. Widespread and systemic application of clinical audit may improve the quality of patient care and maintain the trust of the population. However, clinical audit should be effective and cost-effective. The recently published methodological guideline by the Ministry intends to promote good practice in clinical audit.

[Comparative analysis of the non-profit, for-profit and public hospital providers: American experiences]. / Nyereségorientált kórházi szolgáltatóvá válás elonyei és hátrányai: amerikai tapasztalatok.

BACKGROUND AND OBJECTIVES: The new legislation allowed hospitals and other health care facilities to be converted into for-profit status. The detailed regulatory framework is under development in Hungary. This article reviews the literature of studies comparing hospital financial performance and the quality of care before and after conversion from public or non-profit status to for-profit. METHODS: Studies were identified through electronic search of Medline (Pubmed), EconLit, Cochrane Library, Economic Evaluation Database (EED), az Health Technology Assessment (HTA) databases, library files and reference lists. The literature search was extended to the Internet, World Bank, International Labor Office (ILO), Organization for Economic Cooperation and Development (OECD), and WHO websites as well as government, academic institutions and large insurance companies web pages for unpublished online information. Time series and before-after studies and systematic literature reviews were included. RESULTS: The conversion from non-profit to for-profit status improved the profitability of the hospitals. However the quality of care (measures in mortality, frequency of side effects, complications) might suffer in the first couple years of the conversion. The conversion may increase the total health care expenditures per capita. Trustful relationship between patients and physicians may also be threatened. CONCLUSION: The generalisability of the American experiences into the Hungarian single payer system may be limited. From societal point of view, for-profit providers could provide socially beneficial care in areas where it is possible to define, monitor and evaluate the nature and quality characteristics of the services, as well as market competition can be ensured. However most of the healthcare services are too complex to fall into this category.

Health care reform in six Central European countries. A focus on health economic requirements in the drug pricing and reimbursement processes.

This study gives an overview of the health care reform in six Central European countries after the transition from a central planning system to a regulated market economy. We focused on cost containment policies for drugs, especially the requirements for submitting health economic data in the pricing and/or reimbursement processes. The literature review was supplemented with a survey with decision makers at national health authorities in each country. The study covered Croatia, Czech Republic, Hungary, Poland, Slovakia, and Slovenia. All countries had in common that health economic information was used in reimbursement rather than in pricing processes. Differences between the six countries were mainly variations in the relative importance of health economic data and the presence of explicit requirements and guidelines. Published health economic guidelines exist in two countries and one of the six countries applies a mandatory submission system for a selected range of new drugs. In most of the Central European countries it is more typical that authorities issue a brief list of required data for reimbursement submissions that include health economic information among other data. There is a generally widespread expectation towards more systematic and formalized requirements for health economic and outcomes research data appearing within the next 3-5 years in the region.