Differences in outpatient corticosteroid prescribing patterns between attending and house staff physicians as an indicator of the quality of supervision.

Computerized information systems have become an indispensable source of quality improvement data in the healthcare field. The degree to which we are successful in using these systems is limited only by our ability to ask the right questions. In this study, computerized patient records were used to evaluate the uniformity in the prescribing patterns for oral corticosteroids among house staff and attending physicians as a measure of the adequacy of resident supervision in the outpatient setting. Retrospective analysis of the records of 771 outpatients receiving prescriptions for oral corticosteroid preparations over 1 year in a large tertiary-care university-affiliated Department of Veterans Affairs Medical Center indicated different prescribing patterns for attending physicians and house staff. Additionally, it was noted that house staff tended to manage more complex patients than did attending physicians. We further evaluated the clinical outcomes of these patients to assess the quality, appropriateness, and comparability of care within cohorts of patients and to determine the degree to which resident supervision may have affected outcomes. The study results suggest that there is an opportunity to improve the management of patients treated with oral corticosteroid therapy by increasing staff physician involvement either through direct care of the most complex cases or through enhanced resident supervision.

Generic screening as an integral part of quality management.

Comprehensive quality management programs are vital to the evaluation and improvement of the delivery of health care today and in the future. These programs must address issues which include quality assurance, risk management, and utilization management. The programs should be designed to promote and assist in the safe delivery of patient care as well as the provision of a safe environment for all patients, visitors, and employees. Various methodologies have been advocated to ensure quality care, the majority of which are retrospective evaluations. One of the more recent methodologies developed is generic screening. The Boston Veterans Medical Center has utilized generic screening since 1986 in its Quality Management Program. Our generic screening program has been successful as a result of multidisciplinary collaboration, commitment, and support from the medical center's top management, both administrative and clinical. We have developed a credible system that may be used to fulfill many requirements of both internal and external reviews. The program is easily reproducible and provides a basis for trend analysis within specific groups in order to better plan and meet patient care needs, minimize risk, and maximize outcome.