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.
Dr. Asao was a third-year resident, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, at the time of this project. Currently, she is a fellow, Metabolism, Endocrinology & Diabetes, University of Michigan Health System, Ann Arbor, Michigan.
Dr. Mansi is professor and program director, Primary Care Track in Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
Dr. Banks is professor and head, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
Correspondence should be addressed to Dr. Mansi, Department of Medicine, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130; telephone: (318) 675-7574; e-mail: (email@example.com).