Resident Chart Audit Resident Chart Audit and QI Projectand QI Project

Everyone Everyone andand

Larry Ward, MDLarry Ward, MD

Chart AuditsChart Audits Ultimate goal is to improve quality of Ultimate goal is to improve quality of

carecare Adherence to guidelines for therapeutic Adherence to guidelines for therapeutic

and preventive measuresand preventive measures Also a method for measuring Also a method for measuring

prevalenceprevalence

Newly mandated by the ACGMENewly mandated by the ACGME Mandated as part of IM recertificationMandated as part of IM recertification

Resident Chart AuditsResident Chart Audits Performed for at least 3 of the last 4 Performed for at least 3 of the last 4

yearsyears Method changed last year:Method changed last year:

22ndnd and 3 and 3rdrd years choose 15 charts to years choose 15 charts to review between January and Marchreview between January and March

Cancer screeningCancer screening Diabetes managementDiabetes management HTN managementHTN management CAD managementCAD management

Resident Chart AuditsResident Chart Audits Data for the entire practice is collated Data for the entire practice is collated

Over 900 charts reviewed this yearOver 900 charts reviewed this year Reviewed during Preclinic conference Reviewed during Preclinic conference

in Aprilin April Each individual is given the following:Each individual is given the following:

Their own raw and collated dataTheir own raw and collated data Entire practice data for 2008 and 2009Entire practice data for 2008 and 2009 National dataNational data IBC data for Jones Hall and MGPIBC data for Jones Hall and MGP

ResultsResults Compared with 2008:Compared with 2008:

PreventionPrevention 74% Flu vaccine (+ 5%)74% Flu vaccine (+ 5%) 79% Pneumovax (+10%)79% Pneumovax (+10%) 72% Mammogram (+ 1%)72% Mammogram (+ 1%)

Colorectal screening (unreliable)Colorectal screening (unreliable) PAP smears (- 7%)PAP smears (- 7%)

ResultsResults Compared with 2008:Compared with 2008:

CADCAD 79% B-blocker (+3%)79% B-blocker (+3%) 84% on Anti-platelet (+5%)84% on Anti-platelet (+5%) 61% LDL <100 (+9%)61% LDL <100 (+9%)

ResultsResults Compared with 2008:Compared with 2008:

DiabetesDiabetes 73% A1c check in last 6 months (0%)73% A1c check in last 6 months (0%) 75% A1c <9.0 (New)75% A1c <9.0 (New) 59% seen Ophtho (+ 9%)59% seen Ophtho (+ 9%) 61% LDL <100 (+ 9%)61% LDL <100 (+ 9%) 60% at BP goal <130/90 (- 1%)60% at BP goal <130/90 (- 1%) 86% on ACE/ARB (+ 0%)86% on ACE/ARB (+ 0%)

ConclusionConclusion Improvements in most areas compared Improvements in most areas compared

with 2008.with 2008. Compares favorably with national data.Compares favorably with national data. Residents to develop personal, data Residents to develop personal, data

driven QI plans this upcoming year.driven QI plans this upcoming year. Mid year review with facultyMid year review with faculty Repeat chart audit (?by peers?) next springRepeat chart audit (?by peers?) next spring

QI initiatives in the practice this year QI initiatives in the practice this year targeting deficienciestargeting deficiencies