This is essentially the approach used as part of "Clinical Audit" in the
UK. Sometimes useful changes are produced!
To me, the main points is to get the "stakeholders" on board before you
start. Get people to articulate and agree what they ought to be doing
(EBP) and then measure whether they are doing it or not.
Having already agreed what they ought to be doing, they can hardly
refuse to change if they find practice differs from what they have
What often happens, alas, is for a lot of "baseline data" to be
collected with insufficient preparation with the stakeholders, followed
by rather inconclusive analyses and discussions/arguements about whether
change is necessary, desirable, possible etc.
All the best.
Clinical Audit Analyst
Burton Hospitals NHS Trust
In message <[log in to unmask]>, Janet Martin
<[log in to unmask]> writes
>When considering what effectively changes prescribing practice, a
>variety of interventions have been systematically reviewed (i.e. practice
>guidelines, CME, audit & feedback, patient-mediated strategies, academic
>detailing, etc, etc). But no where have I seen CQI methods
>systematically reviewed. Has anyone looked at this? Is anyone in the
>process of looking at this? Does good evidence exist to suggest CQI
>works to bring about meaningful and lasting change in practice?
>Don Berwick, head of the Institute for Healthcare Improvement in Boston,
>advocates using PDSA quick-cycle testing (i.e. Plan the change; Do the
>change, Study the results, Act on the results) for measuring whether
>changes in practice have lead to improvment. (See Ann Intern Med
>1998;128:460-466) This quick-cycle testing produces rapid results at the
>front-lines of medicine by advocating measuring small, representative
>samples, avoiding long baseline collection periods, and striving for
>practicality rather than perfection in data collection. Obviously, this
>approach is far from the methodologic rigour we prefer, but Berwick's
>point is that this approach is practical and gets physicians (and other
>practitioners) measuring things and making changes in their practice that
>otherwise would never get done. He purports that this method is
>preferable to not doing anything at all. This quick-cycle approach has
>been used by a variety of tertiary care institutions in the US, and has
>resulted in "reducing costs of care while improving outcomes" under the
>tutelage of Berwick and IHI.
>I welcome your input on the merits and risks of this CQI approach to
>improving prescribing practice.
>Thanks in advance,
>Janet Martin, PharmD
>Evidence-Based Prescribing Guidelines Pharmacist
>London Health Sciences Centre
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