Academic Medicine

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Academic Medicine:
doi: 10.1097/ACM.0b013e3181c03671
Quality and Safety

Improving Quality in an Internal Medicine Residency Program Through a Peer Medical Record Audit

Asao, Keiko MD, MPH, PhD; Mansi, Ishak A. MD; Banks, Daniel MD, MS

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Purpose: This study examined the effectiveness of a quality improvement project of a limited didactic session, a medical record audit by peers, and casual feedback within a residency program.

Method: Residents audited their peers' medical records from the clinic of a university hospital in March, April, August, and September 2007. A 24-item quality-of-care score was developed for five common diagnoses, expressed from 0 to 100, with 100 as complete compliance. Audit scores were compared by month and experience of the resident as an auditor.

Results: A total of 469 medical records, audited by 12 residents, for 80 clinic residents, were included. The mean quality-of-care score was 89 (95% CI = 88–91); the scores in March, April, August, and September were 88 (95% CI = 85–91), 94 (95% CI = 90–96), 87 (95% CI = 85–89), and 91 (95% CI = 89–93), respectively. The mean score of 58 records of residents who had experience as auditors was 94 (95% CI = 89–96) compared with 89 (95% CI = 87–90) for those who did not. The score significantly varied (P = .0009) from March to April and from April to August, but it was not significantly associated with experience as an auditor with multivariate analysis.

Conclusions: Residents' compliance with the standards of care was generally high. Residents responded to the project well, but their performance dropped after a break in the intervention. Continuation of the audit process may be necessary for a sustained effect on quality.

© 2009 Association of American Medical Colleges


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