Janet Harris
Academic Director, Health Sciences
University of Oxford
Centre for Professional Development
16/17 St Ebbes Street
Oxford  ENGLAND
OX1 1PT

01865 286944/286942

-----Original Message-----
From: Mark Newman [mailto:[log in to unmask]]
Sent: 13 June 2002 17:01
To: [log in to unmask]
Subject: Re: audits as evidence

Dear Alan

interesting question and interesting suggestions from both yourself and Janet. Made me think about this again - My first question to you both would be why do you ask and why does it matter? From an EBP perspective (You don't say which masters course but Janet's is EBHC) I guess that we are thinking about the questions; is this evidence good enough for me to use?, is this applicable in my setting?, what do the results mean for my patients? My thinking is that i am not sure these questions apply to audit or at least they do not apply in the same way as they do to research.

This is based on my view that audit and research are entirely distinct activities, both exceedingly important, sharing a basis in rational empiricism and requiring a systematic methodical approach but distinct nevertheless. The distinction in my view arises from the difference in purpose that the activities have (or should have) -

You do research when you try to find out something to which the answer is not known.

You do audit when the answer is known and your team are trying to achieve the same outcomes in your practice i.e. in the audit cycle. Evidence obtained from research is used to set standards and determine the way something should be done e.g Patients with heart failure given educational intervention both written and verbal support and advice on medication during hospitalization and post discharge results in 57% RRR in readmission for heart failure (Blue L, Lang E, McMurray JJ, et al. Randomised controlled trial of specialist nurse intervention in heart failure. BMJ 2001 Sep 29;323:715-8.) You implement programme as described then monitor for example readmission rates to see if you achieve the desired standard e.g 57% RRR. If not investigate the way your intervention is delivered to see why. Then repeat cycle.

Or putting it another way primary aim of audit is (or should be) to improve practice whilst primary aim of research is to improve knowledge.

In this sense I have always thought of audits as providing evidence for one's own practice not for anyone else and have viewed articles published about audits as sources of information rather than evidence. It may be the case that data collected for monitoring (which could be thought of as a form of audit) if collected over long periods done well etc could be used for research purposes - In such cases it seems to me that we have moved away from audit too research and should critically appraise and interpret particular studies accordingly.

Not sure where this leaves the answer to your question. Audit is a relatively simple yet potentially powerful process for practice development - I think that there is a consensus is that it has not so far lived up to its hype - there are a whole variety of reasons why this might be the case but I can't help thinking that at least part of the reason is that is has got caught up in the web of doing research and getting publications - Clinical staff in hospitals I have worked with have often told me about audit projects which actually transpire to be attempts at research and vice -versa - If our practitioners/ students are concerned about where audit fits into the hierarchy of evidence perhaps the question we should be asking them is what is the difference between research and audit.

Once again good question - hope this is further food for thought

mark

On 13 Jun 02, at 8:49, A.J.O'rourke wrote:

> Dear all:

> As part of some model answers I am writing for a masters course, the

> following question has come up:

>

> Where would the results of an audit sit in the "hierarchy of

> evidence"?

>

> My own feeling is that most audits fall into the category of quasi-

> scientific studies, with prospective audits, where the staff set out

> to collect specific focussed data having more validity than

> retrospective projects, which hope they can extract adequate data from

> records collected for quite different purposes. Maybe a prospective

> audit would have the standing of say a cohort study; a retrospective

> audit that of a case-control study.

>

>

> Any ideas?

> Rgds Alan

>

> Alan O'Rourke Lecturer Wisdom Centre for Network Learning

> http://wisdomnet.co.uk/index.html Institute of General Practice

> Community Sciences Centre Northern General Hospital Sheffield S5

> 7AU Tel: 0114 271 5095 E-mail: [log in to unmask]

Mark Newman

ESRC Research Fellow

School of Life Long Learning and Education &

School of Health & Social Sciences

Middlesex University

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