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Auditing chronic disease care: Does it make a difference?
Vivien Essel1, Unita van Vuuren, Angela De Sa
1Public Health Registrar, University of Cape Town and Western Cape Provincial Health Services. vabaiden@yahoo.com.
Insights
Clinical audits show value in improving chronic disease care over time. Districts with longer audit participation demonstrated better care processes than newer participants, indicating long-term benefits.
Area of Science:
- Public Health
- Healthcare Management
- Quality Improvement
Background:
- An integrated audit tool for diabetes, hypertension, asthma, COPD, and epilepsy was implemented in South Africa's Western Cape Province.
- Annual audits commenced in 2009, with all six districts participating by 2012.
Purpose of the Study:
- To evaluate the impact of clinical audits on chronic disease care within health districts.
- To determine if sustained participation in audits leads to improved healthcare quality over time.
Main Methods:
- Internal audits assessed primary healthcare facility processes and equipment.
- Folder reviews of 10 patient records per condition per facility were conducted using random systematic sampling.
- Comparative analysis contrasted districts with long-term audit participation ('2012 old') versus recent participation ('2012 new').
Main Results:
- The number of audited facilities increased significantly from 29 (2009) to 129 (2012).
- Districts with longer audit history ('2012 old') showed improvements compared to newly participating districts ('2012 new').
- Newly participating districts were less likely to record clinical processes (OR 0.25, 95% CI 0.21-0.31).
Conclusions:
- Sustained clinical audits are valuable for enhancing chronic disease care processes.
- Long-term audit participation correlates with improved healthcare quality.
- The study suggests audits contribute to better patient outcomes through process improvements.
Background:
An integrated audit tool was developed for five chronic diseases, namely diabetes, hypertension, asthma, chronic obstructive pulmonary disease and epilepsy. Annual audits have been done in the Western Cape Metro district since 2009. The year 2012 was the first year that all six districts in South Africa's Western Cape Province participated in the audit process.
Aim:
To determine whether clinical audits improve chronic disease care in health districts over time.
Setting:
Western Cape Province, South Africa.
Methods:
Internal audits were conducted of primary healthcare facility processes and equipment availability as well as a folder review of 10 folders per chronic condition per facility. Random systematic sampling was used to select the 10 folders for the folder review. Combined data for all facilities gave a provincial overview and allowed for comparison between districts. Analysis was done comparing districts that have been participating in the audit process from 2009 to 2010 ('2012 old') to districts that started auditing recently ('2012 new').
Results:
The number of facilities audited has steadily increased from 29 in 2009 to 129 in 2012. Improvements between different years have been modest, and the overall provincial average seemed worse in 2012 compared to 2011. However, there was an improvement in the '2012 old' districts compared to the '2012 new' districts for both the facility audit and the folder review, including for eight clinical indicators, with '2012 new' districts being less likely to record clinical processes (OR 0.25, 95% CI 0.21-0.31).
Conclusion:
These findings are an indication of the value of audits to improve care processes over the long term. It is hoped that this improvement will lead to improved patient outcomes.
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