Development and implementation of a medical audit model based on quality assurance and participatory supervision in Ecuador

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DOI:

https://doi.org/10.5712/rbmfc12(39)1417

Keywords:

Medical Audit. Quality Circles. Quality Assurance in Health Care.

Abstract

Objectives: This study is a description of the development of a medical audit strategy based on quality provision assurance using tools of participatory supervision in an attempt to generate cooperation between the auditor and the auditee in health services of the first level of  Primary Attention to Health Care of the Ministry of Public Health of Ecuador. Methods: A methodology was developed, implemented and field tested, based on a description of the results (cross-section study). Results: At the beginning of the process, the clinical relevant scores, in general, did not exceed 45% and in relation to legal risks they did not exceed 65%. Progressively, an increase in the score was observed. Additionally, results obtained from the auditees’ perception of this process were obtained, with less resistance in less than 5% of the cases, perhaps due to the participatory nature of the process. Conclusion: The medical audit process is essential for the identification of problems, but it is also necessary to be an active process with their intervention and resolution. The Medical Audit identifies hidden problems for decision-makers and decreases the resistance to the inclusion of strategies for quality improvement.

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Author Biography

Fausto Gady Torres Toala, Makroscopio Servicios de Salud

Fausto Gady Torres Toala

Especialista en Salud Publica, Medicina Familiar y Calidad en Salud. 

Investigador Principal de Makroscopio Servicios de Salud

Docente en Universidad Catolica del Ecuador y Universidad Central del Ecuador.

References

Mintzberg H, Quinn JB, Voyer J. El proceso estratégico: Conceptos, contextos y casos. Naucalpan de Juárez: Prentice-Hall Hispanoamericana; 1997.

Mintzberg H. La estructuración de las organizaciones. Esplugues de Llobregat Barcelona: Ariel; 2012.

Sedano AM. La supervisión educativa. Bordón Rev Pedagog. 1991;43(2):177-86.

Holloway EL, Neufeldt SA. Supervision: its contributions to treatment efficacy. J Consult Clin Psychol. 1995;63(2):207-13. DOI: http://dx.doi.org/10.1037/0022-006X.63.2.207 DOI: https://doi.org/10.1037/0022-006X.63.2.207

Mintzberg H, McHugh A. Strategy Formation in an Adhocracy. Adm Sci Q. 1985;30(2):160-97. DOI: http://dx.doi.org/10.2307/2393104 DOI: https://doi.org/10.2307/2393104

Dewulf A, Gray B, Putnam L, Lewicki R, Aarts N, Bouwen R, et al. Disentangling approaches to framing in conflict and negotiation research: A meta-paradigmatic perspective. Hum Relat. 2009;62(2):155-93. DOI: http://dx.doi.org/10.1177/0018726708100356 DOI: https://doi.org/10.1177/0018726708100356

Oetzel JG, Ting-Toomey S. Face Concerns in Interpersonal Conflict: A Cross-Cultural Empirical Test of the Face Negotiation Theory. Commun Res. 2003;30(6):599-624. DOI: http://dx.doi.org/10.1177/0093650203257841 DOI: https://doi.org/10.1177/0093650203257841

Lewicki RJ, Weiss SE, Lewin D. Models of conflict, negotiation and third party intervention: A review and synthesis. J Organ Behav. 1992;13(3):209-52. DOI: http://dx.doi.org/10.1002/job.4030130303 DOI: https://doi.org/10.1002/job.4030130303

Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD. Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback. Qual Saf Health Care. 2006;15(6):433-6. DOI: http://dx.doi.org/10.1136/qshc.2006.018549 DOI: https://doi.org/10.1136/qshc.2006.018549

Paton JY, Ranmal R, Dudley J; RCPCH Clinical Standards Committee. Clinical audit: still an important tool for improving healthcare. Arch Dis Child Educ Pract Ed. 2015;100(2):83-8. DOI: http://dx.doi.org/10.1136/archdischild-2013-305194 DOI: https://doi.org/10.1136/archdischild-2013-305194

Neuspiel DR, Stubbs EH, Liggin L. Improving reporting of outpatient pediatric medical errors. Pediatrics. 2011;128(6):e1608-13. DOI: http://dx.doi.org/10.1542/peds.2011-0477 DOI: https://doi.org/10.1542/peds.2011-0477

Hysong SJ, Best RG, Pugh JA. Audit and feedback and clinical practice guideline adherence: making feedback actionable. Implement Sci. 2006;1:9. DOI: http://dx.doi.org/10.1186/1748-5908-1-9 DOI: https://doi.org/10.1186/1748-5908-1-9

Runyon KE. Some interactions between personality variables and management styles. J Appl Psychol. 1973;57(3):288-94. DOI: http://dx.doi.org/10.1037/h0034723 DOI: https://doi.org/10.1037/h0034723

Spector PE. Behavior in organizations as a function of employee’s locus of control. Psychol Bull. 1982;91(3):482-97. DOI: http://dx.doi.org/10.1037/0033-2909.91.3.482 DOI: https://doi.org/10.1037/0033-2909.91.3.482

Mitchell TR, Smyser CM, Weed SE. Locus of Control: Supervision and Work Satisfaction. Acad Manage J. 1975;18(3):623-31. DOI: http://dx.doi.org/10.2307/255692 DOI: https://doi.org/10.2307/255692

Katz FM, Snow R. Evaluación del rendimiento de los trabajadores de la salud: Manual de formación y supervisión. Cuad Salud Púbica OMS [Internet]. 1981. [citado 2016 Nov 22]. Disponible en: http://bases.bireme.br/cgi-bin/wxislind.exe/iah/online/?IsisScript=iah/iah.xis&src=google&base=PAHO&lang=p&nextAction=lnk&exprSearch=1619&indexSearch=ID

Hysong DS. Meta-analysis: audit and feedback features impact effectiveness on care quality. Med Care. 2009;47(3):356-63. DOI: http://dx.doi.org/10.1097/MLR.0b013e3181893f6b DOI: https://doi.org/10.1097/MLR.0b013e3181893f6b

Neuspiel DR, Stubbs EH. Patient safety in ambulatory care. Pediatr Clin North Am. 2012;59(6):1341-54. DOI: http://dx.doi.org/10.1016/j.pcl.2012.08.006 DOI: https://doi.org/10.1016/j.pcl.2012.08.006

Shumaker SA, Ockene JK, Riekert KA, eds. The Handbook of Health Behavior Change. 3rd Ed. New York: Springer; 2008. 856 p.

Gas HGA, González BM. Calidad y liderazgo en medicina. Rev CONAMED [Internet]. el 28 de abril de 2015. [citado 2017 Abr 27];18(4):172-82. Disponible en: http://www.dgdi-conamed.salud.gob.mx/ojs-conamed/index.php/revconamed/article/view/127

Jimenez Trespalacios E. Diseño del programa de auditoria para el mejoramiento de la calidad de la atencion en salud de la unidad funcional de hospitalizacion de la policlinica Ismael Dario Rincon, en la regional de salud del Magdalena Medio de Ecopetrol s.a. en Barrancabermeja. [Internet] [Thesis]. 2012 [citado 2017 Abr 27]. Disponible en: http://bdigital.ces.edu.co:8080/repositorio/handle/10946/305

Jiménez Cangas L, Báez Dueñas RM, Pérez Maza B, Reyes Alvarez I. Metodología para la evaluación de la calidad en instituciones de atención primaria de salud. Rev Cubana Salud Pública. 1996;22(1):15-6.

Isermann R. Supervision, fault-detection and fault-diagnosis methods - An introduction. Control Eng Pract. 1997;5(5):639-52. DOI: http://dx.doi.org/10.1016/S0967-0661(97)00046-4 DOI: https://doi.org/10.1016/S0967-0661(97)00046-4

O’Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2007;(4):CD000409. DOI: https://doi.org/10.1002/14651858.CD000409.pub2

Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;(6):CD000259. DOI: https://doi.org/10.1002/14651858.CD000259.pub3

Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009;(2):CD003030. DOI: https://doi.org/10.1002/14651858.CD003030.pub2

Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006;(2):CD000259. DOI: https://doi.org/10.1002/14651858.CD000259.pub2

Watkins Jr CE. Does Psychotherapy Supervision Contribute to Patient Outcomes? Considering Thirty Years of Research. Clin Superv. 2011;30(2):235-56. DOI: http://dx.doi.org/10.1080/07325223.2011.619417 DOI: https://doi.org/10.1080/07325223.2011.619417

Zhelev Z, Abbott R, Rogers M, Fleming S, Patterson A, Hamilton WT,

et al. Effectiveness of interventions to reduce ordering of thyroid function tests: a systematic review. BMJ Open. 2016;6(6):e010065. DOI: http://dx.doi.org/10.1136/bmjopen-2015-010065 DOI: https://doi.org/10.1136/bmjopen-2015-010065

González-Juanatey JR, Alegría-Ezquerra E, Aznar-Costa J, Bertomeu-Martínez V, Franch-Nadal J, Palma-Gámiz JL. Conocimiento y aplicación de las guías de práctica clínica sobre riesgo cardiovascular en las consultas generales y especializadas. Rev Esp Cardiol. 2006;59(8):801-6. DOI: http://dx.doi.org/10.1157/13091884 DOI: https://doi.org/10.1157/13091884

Letelier SML, Moore P. La medicina basada en evidencia: Visión después de una década. Rev Méd Chile. 2003;131(8):939-46.

Rello J, Lorente C, Bodí M, Diaz E, Ricart M, Kollef MH. Why do physicians not follow evidence-based guidelines for preventing ventilator-associated pneumonia?: a survey based on the opinions of an international panel of intensivists. Chest. 2002;122(2):656-61. DOI: http://dx.doi.org/10.1378/chest.122.2.656 DOI: https://doi.org/10.1378/chest.122.2.656

Published

2017-06-22

How to Cite

1.
Torres Toala FG. Development and implementation of a medical audit model based on quality assurance and participatory supervision in Ecuador. Rev Bras Med Fam Comunidade [Internet]. 2017 Jun. 22 [cited 2024 Jul. 3];12(39):1-11. Available from: https://rbmfc.org.br/rbmfc/article/view/1417

Issue

Section

Research Articles

Plaudit