Auditing Nonphysician Providers' Visits through a Computer-Assisted System

Abstract

The Medical Department is using a computer-assisted system for auditing care provided by mid-level practitioners. Standards of care and corresponding checklist forms have been developed for six common ambulatory problem areas. These include: Respiratory complaints, headache, gastrointestinal disorders, urinary tract infections, male genitourinary problems, and minor trauma. The standards for the diagnostic process and treatment of each complaint were developed by a working group of physicians and mid-level practitioners. Providers complete a checklist form for each patient presenting with problems covered by the protocol. The checklist serves as the medical record for the visit. Checklist data is entered into a computer which audits the visit record against protocol standards. The computer identifies records containing discrepancies in the appropriateness of diagnosis, treatment plan, and physician consultation. The computer output is not the end of the audit process. It identifies encounter records which need further review. Because a discrepancy from the programmed standards does not necessarily reflect faulty medical judgement or care, these records are referred weekly to a physician-nurse audit team. The computerized system allows the auditors to focus their efforts on problems which may make a significant difference in patient care.

As a result, the Medical Department's audit process is both more comprehensive and more thorough than it was prior to the inception of this program. Since April 1, 1977, more than 15,000 encounters have been audited through this system.