Establishing a quality improvement process for identification of psychosocial problems in a primary care practice

A quality improvement process that will significantly increase the rate of identification of psychosocial problems through routine use of case-finding instruments can be established in a general medicine practice.

Two groups of patient examination reports written by physicians were retrospectively compared with the patients' responses on the case-finding database instrument. The samples were obtained by sequential selection in four time periods.

The study occurred in a university general internal medicine practice that utilizes the problem-oriented record. The patients studied were seen for first-time comprehensive examinations designed to identify all important health problems, including psychosocial problems.

The authors compared performances of the physicians in identification of psychosocial problems before and after the intervention, which consisted of a pilot study audit of psychosocial problem identification, establishment of standards for interpretation of the case-finding instrument, design of a flow sheet to make case-finding data clearly available to the physician at each comprehensive examination, and feedback of physician performance according to practice-adopted standards for identification of psychosocial problems.

The result of the intervention was an increase in psychosocial problem identification from 67% to 90% of problems present, p less than 0.05 by chi-square distribution; or a decrease from 33% to 10% in psychosocial problems missed by the physicians.

The quality improvement process for identification of psychosocial problems described in this report significantly increased the rate of identification of psychosocial problems by general internists.