on 13/6/02 5:00 pm, Mark Newman at [log in to unmask] wrote:
> 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
I have to disagree ever so slightly. Call me a pedant but these terms DO
matter when you come to do an audit. I would draw attention to:
1 Criteria and standards are not the same thing. Research can set criteria
(what is the right thing to do?) but rarely can it set the standard (how
often do we do the right thing?) e.g. research tells you that ACE inhibitors
prolong the life of people with heart failure. You decide that a CRITERION
in your audit is that your patients with heart failure should be on ACE
inhibitors. The real world being what it is, you will not have 100% of
patients on them (some have contra-indications, some have reacted badly etc)
so you set the STANDARD say that 95% of your patients with heart failure
should be on ACE inhibitors and conduct an audit to see if that is the case.
2 Setting standards is not easy - where do you start? Sometimes research can
help e.g. a research project that uses the method of a national survey finds
that only 70% of people with heart failure are on ACE inhibitors, but that
this varies between GPs from 30 to 85%. So you decide that your standard
should be as good as the best - say at least 85%
3 The real world being what it is, you sometimes have to set standards
'intuitively' (I will let you guess what I mean) and then try the next time
around to better them. One thing I have found helps to make this iteration
more objective is using methods developed for research namely confidence
intervals (ref Hopayian, K Morley, S. Putting confidence into audit: using
confidence intervals to set objective standards in primary care audits. The
Journal of Clinical Governance 2001; 9: 67-70)
--
Kev (Kevork) Hopayian
GP, The Surgery, Main St, Leiston, Suffolk, IP16 4ES, England
Tel +44 (0)1728 830526
Fax +44 (0)1728 832029
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