Practicing family physicians need to monitor and improve care provided to their patients. The College of Family Physicians of Canada recognizes the importance of skill development in this area, as outlined in their program guidelines “General Information and Regulations on Program Accreditation and Examinations”:
“Family physicians must be able to assess their own skills, knowledge, and practices through practice audit and other quality assurance activities. Residents must learn the basic principles of quality assurance, including setting standards, measuring performance against those standards, and follow-up to ensure they were met; residents must participate in practice audit activities during their residency training.”
In PGY2, all residents, in collaboration with their faculty advisor and community preceptor, must complete a community based PQI during a major Family Medicine rotation. The PQI project must be done individually and must be presented to the clinic before the completion of the rotation. A copy of the project must be submitted to the Program.
This PQI Project is mandatory for all residents. Because the project will require active data collection and analysis, it is advisable to contact both your faculty advisor and your community preceptor to agree on your project, refine the question and collect relevant references prior to community family medicine blocktime.
* All urban residents must complete and present a "Practice" PQI during PGY1 Family Medicine Blocktime.
* Some of the projects will be chosen for presentation at Family Medicine Research Day.
* A PQI project involves skills including database searching and critical appraisal / evidence-based medicine.
- To provide family medicine residents the opportunity to develop skills required to implement the process of quality assessment and improvement in clinical practice.
- To meet the “audit” requirement outlined in the educational requirements of the College of Family Physicians of Canada.
A quality improvement project can be done on any activity: clinical (e.g. how regular are BPs done and recorded on a chart), administrative (e.g. how can we improve our clinic’s handling of patients’ requests for prescription renewals), evaluative (e.g. does the CHOICE program decrease the cost of geriatric care), etc.
Perusing some of the PQI projects that have been done by past residents will give an impression of the wide variety of projects that can be carried out.
This part requires the most thought and refinement. There must be agreement between the resident and the community preceptor with input from the faculty advisor as to the focus of the problem.
Setting the Standard (Defining Quality)
In order to determine the standard for data comparison, a review and critical appraisal of the relevant literature must be done. For example, if the study involves whether an annual lab evaluation of diabetics is appropriate, a consensus by Canadian diabetic experts must be determined. In some projects, there may be very little literature and the resident may have to canvass personal opinions of experts. Occasionally, an arbitrary standard will be used.
The resident and the community preceptor must be in agreement as to the “gold standard.”
Data can be collected retrospectively or prospectively. Depending on the project, collection may involve chart audit, surveys, data sheets, check lists, interviews, etc.
Accumulated data can be stored / presented in many different ways depending on the data. However it exists, the data must be analyzed and compared to what has been agreed earlier as the gold standard.
Analysis of the data should lead to conclusions and proposals for change: if the defined standard has not been achieved, what corrective processes need to be done to achieve the standard? If the standard has been surpassed, is it the right standard? Recommendations should follow from the analysis of data and conclusions reached.
After agreed recommendations have been put in place, a resurvey should be carried out after appropriate time has passed to see if the agreed solutions have achieved the desired results. Any follow-up surveys will probably not be carried out by the resident, due to the time limitations of second year training.