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Effectiveness and cost-effectiveness of medical audit: Coronary thrombolysis as an example

Robinson, Michael Barney; (1994) Effectiveness and cost-effectiveness of medical audit: Coronary thrombolysis as an example. Doctoral thesis (M.D), UCL (University College London). Green open access

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Abstract

A programme of audit was set up in four district general hospitals to investigate the feasibility of measuring effectiveness and cost-effectiveness in each hospital. The topic, selected by the participating physicians from a short-list drawn up by the investigators, was the use of intravenous thrombolysis for suspected myocardial infarction. After baseline observations, each hospital set standards. A further three rounds of feedback took place over the subsequent 12 months. Similar observations, but no feedback, took place at a control hospital. Effectiveness was defined as the increase in the proportion of suspected infarcts given thrombolysis above and beyond that expected from observations in the control hospital. In one hospital, the baseline proportion was 94%; this provided little scope for further improvement and measured effectiveness was zero. Despite this, the audit meetings were well attended. In the other hospitals the baseline proportions ranged from 53-60% and those observed in the final round of audit from 68-93%. Increases were greater in each of the three study hospitals than in the control but the difference was statistically significant only in one. The central estimates of cost-effectiveness in these three hospitals varied from £101 to £392 of audit costs per extra case given thrombolysis. Equivalent figures for cost- utility were £1700 to £2500 per QALY. Confidence limits around these estimates were wide. Interpretation of the results was limited by the smaller than expected numbers of eligible cases and uncertainty about the validity of generalising such findings. The main conclusions drawn are (1) routine audit of suspected as opposed to confirmed infarcts may be difficult; (2) junior staff on short attachments are unlikely to be convinced that audit produces changes in practice because of small numbers; (3) estimates of effectiveness and cost- effectiveness are of limited use for evaluating audit in one hospital compared to another; (4) cost-utility compares favourably with some treatment interventions but unfavourably with preventative ones; (5) qualitative approaches to evaluation of audit should be considered, and some examples are suggested.

Type: Thesis (Doctoral)
Qualification: M.D
Title: Effectiveness and cost-effectiveness of medical audit: Coronary thrombolysis as an example
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Thesis digitised by ProQuest.
Keywords: Health and environmental sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10109485
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