Clinical audit and research

12. Clinical audit and research

Herbert Thurston





• Research136








Clinical audit






• Ascertains whether an existing service reaches a predetermined standard.


• Involves interrogation of records or completing a questionnaire.


• Research ethics committee review is not required.


Research






• Often is deductive and concerned with critical testing.


• May involve a new treatment, additional therapy and investigations.


• May involve random allocation to treatment or control groups.


• Requires research ethics committee review and approval.


Clinical audit


Defined in a government White Paper as “the systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome and quality of life for the patient,” audit was introduced into the NHS in 1989. Initially aimed at doctors, subsequently the Department of Health encouraged other healthcare professionals to undertake audit and in 1993 established multiprofessional audit. This led to a change in title to clinical audit, which involves all healthcare professionals.



THE CLINICAL AUDIT CYCLE






• Setting care standards (based on guidelines and expert opinion).


• Preparing a questionnaire for data collection to assess current practice.


• Collation and analysis of data.


• Presenting a summary with recommendations to healthcare providers.


• After an interval, repeating the audit process.


• The latter step of the audit cycle is commonly termed “closing the loop.”


Research



For example, in 1921 a young medical practitioner called Frederick Banting went to the Department of Physiology in the University of Toronto with a new idea about diabetes mellitus which lead to the discovery of insulin in 1922. At that time, it was well known that the pancreas was vital for the maintenance of a normal blood sugar level and removing the pancreas resulted in experimentally induced diabetes mellitus. However, despite many years of research in the best centers in the world, it had not been possible to extract the active hormone from pancreatic tissue. Banting was of the opinion that digestive enzymes became activated in the pancreas, destroying the hormone during the extraction process. Previous studies had shown that pancreatic duct ligation resulted in pancreatic atrophy but diabetes mellitus did not develop. This knowledge allowed Banting to make a pancreatic preparation from which insulin could be isolated. Clearly, a surgical approach would not permit insulin production on a large scale but Banting’s experiments led to the development of laboratory techniques for isolating insulin from the pancreas of pigs and cows. The rest, as they say, is history. Students will be interested to learn that Frederick Banting, who graduated from the University of Toronto, had little or no research experience and his co-worker was still a medical student at the time they discovered insulin. The medical student, Charles Herbert Best, subsequently went on to become Professor of Physiology and Head of the Banting Best Medical Research Institute at Toronto University.


Types of research


Clinical research can be broadly divided into observational research, concerned with collecting data from individual patients or groups of patients, and experimental research which involves comparing the response of groups of patients to different treatment interventions.


OBSERVATIONAL RESEARCH


Studies involving the collection of numeric data, e.g. body weight and height, blood pressure, pulse rate, the range of joint movement, etc. are called quantitative research. This form of research involves the use of tools or questionnaires and provides numeric data which can be subjected to statistical analysis. This can also be used to test hypotheses.

Studies concerned with recording patients’ experiences, thoughts, feelings and perceptions are called qualitative research and usually do not provide numeric data. Such approaches are quite subjective because the researcher collects and interprets descriptive information obtained at interview. An interview may be structured, where each participant is asked to provide answers to a set of fixed questionnaires, or semi-structured, using a set of open-ended questionnaires. Occasionally, unstructured interviews are conducted, allowing the participant to talk about their concerns rather than answering the interviewer’s questions. But inevitably, information from an unstructured interview is more difficult to interpret.


For example, in the early days of cardiac rehabilitation, the coronary unit at the Leicester Royal Infirmary set up a study to discover whether patients found participating in the cardiac rehabilitation program provided by a senior nurse and a physiotherapist was of help to them. The study was designed with advice from an experienced clinical psychologist who then went on to carry out separate semi-structured interviews with both the patient and spouse or partner at home. The whole team were surprised by the main findings. Although it was well known that women are on average 10 years older than men when they suffer a heart attack, the social consequences had not been appreciated. Women patients attending the cardiac rehabilitation sessions were single or widowed and if they had worked, were retired. This was in contrast to men who usually had the support of their spouse or partner and were working prior to suffering their heart attack. Also most women had to take care of themselves following discharge from hospital whereas most men were looked after by their wife or partner. The age and social difference left the women feeling isolated and less able to engage in the rehabilitation group sessions. Many of the women said it was case of “all the boys together.”

Stay updated, free articles. Join our Telegram channel

Sep 25, 2016 | Posted by in PHYSICAL MEDICINE & REHABILITATION | Comments Off on Clinical audit and research

Full access? Get Clinical Tree

Get Clinical Tree app for offline access