Medical audit used for estimation of optimum level of outpatient care

Abstract

Objective - To create a model for determining the optimum level of outpatient medical care and to determine this level.

Design - Expert committees were established comprising one or two hospital physicians and two general practitioners who checked medical records for all outpatient visits to doctors made by a defined population during a defined period of time. the determination of optimum level was made blindly by each member of the expert committee.

Setting and participants - the study comprised all visits to physicians during 10 weeks, in total more than 4000, made by the people in a Swedish community, of which 2084 were randomized.

Results - Total agreement between the members of the committee was initially reached for 84% of the visits and, after a common discussion between the committee members, for 99%. A general practitioner was considered to be the optimum level of care for 76% of the patients in the total series, in the upper ages (above 80) for about 85%.

Conclusion - This method seemed suitable for determining the optimum level of care in a population and may be of value when planning for an optimum health care service. Based on the results from our study it seems reasonable to assume that general practitioners whose training corresponds to that of Swedish ones are competent to treat about 75% of all consultations.

Key Words:

• medical audit
• level of care
• outpatient care
• primary health care