A limited effect on performance indicators from resident-initiated chart audits and clinical guideline education.

ABSTRACT

BACKGROUND AND OBJECTIVES: Clinical practice guidelines are useful as tools to reduce variation and improve clinical outcomes in performance-improvement initiatives. The aim of this study is to examine, in a family medicine residency practice, the effect of incorporating education about clinical practice guidelines for specific medical conditions and services on specific quality of care indicators. METHODS: An educational intervention regarding the implementation of clinical practice guidelines and the use of quality indicators for selected disease states or medical services was developed and implemented into a family medicine residency program. Residents completed a review of the records of selected patients who either were affected by the selected medical condition or were eligible for the medical service being provided, before and after participating in a specific seminar addressing guidelines addressing that condition. RESULTS: Based upon the comparison between the chart reviews, some quality indicators significantly improved following the presentations (ie, documentation of oral examination in children and in patients with chronic illnesses, attempts to decrease medications in patients with anxiety disorders, compliance with measuring HgbA1C in patients with diabetes mellitus), while others did not. CONCLUSIONS: The effect of an organized approach through presentation and chart review of specific quality indicators regarding medical problems frequently encountered in family medicine had a modest and inconsistent effect on the practice behaviors of family medicine residents.