A survey of current audit practice in occupational health

Cashman, Clodagh

doi:10.1093/occmed/kqz066

Cited by 2 publications

(1 citation statement)

References 7 publications

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“…The common approach has been scrutiny of the record using specially developed abstraction tools to examine specific aspects of the health record with a view of generating data for scrutinizing patient outcomes or assessing effectiveness of intervention programs. Many such examples are available from different medical disciplines [4,[7][8][9][10][11], as well as allied health care professions [12][13][14][15][16]. While reliability of audit tools has been specified in most cases, some audit studies have utilized survey type instruments and/ or interviews [14,15] with no indication of reliability data.…”

Section: Introductionmentioning

confidence: 99%

Intra- and inter-rater reliability of an electronic health record audit used in a chiropractic teaching clinic system: an observational study

Injeyan

Hogg‐Johnson

Abdulla

et al. 2021

BMC Health Serv Res

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Background There is a dearth of information about health education clinical file audits in the context of completeness of records and demonstrating program-wide competency achievement. We report on the reliability of an audit instrument used for electronic health record (EHR) audits in the clinics of a chiropractic college in Canada. Methods The instrument is a checklist built within an electronic software application designed to pull data automatically from the EHR. It consists of a combination of 61 objective (n = 20) and subjective (n = 41) elements, representing domains of standards of practice, accreditation and in-house educational standards. Trained auditors provide responses to the elements and the software yields scores indicating the quality of clinical record per file. A convenience sample of 24 files, drawn randomly from the roster of 22 clinicians, were divided into three groups of eight to be completed by one of three auditors in the span of 1 week, at the end of which they were transferred to another auditor. There were four audit cycles; audits from cycles 1 and 4 were used to assess intra-rater (test-retest) reliability and audits from cycles 1, 2 and 3 were used to assess inter-rater reliability. Percent agreement (PA) and Kappa statistics (K) were used as outcomes. Scatter plots and intraclass correlation (ICC) coefficients were used to assess standards of practice, accreditation, and overall audit scores. Results Across all 3 auditors test-retest reliability for objective items was PA 89% and K 0.75, and for subjective items PA 82% and K 0.63. In contrast, inter-rater reliability was moderate at PA 82% and K 0.59, and PA 70% and K 0.44 for objective and subjective items, respectively. Element analysis indicated a wide range of PA and K values inter-rater reliability of many elements being rated as poor. ICC coefficient calculations indicated moderate reliability for the domains of standards of practice, accreditation, and overall file scores. Conclusion The file audit process has substantial test-retest reliability and moderate inter-rater reliability. Recommendations are made to improve reliability outcomes. These include modifying the audit checklist with a view of improving clarity of elements, and enhancing uniformity of auditor responses by increased training aided by preparation of an audit guidebook.

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