Process-of-care failures common in adults with rectal bleeding
(HealthDay)—Among adult primary care patients with rectal bleeding, process-of-care failures are frequent and are associated with poor or fair quality care, according to a study published in the January issue of The Joint Commission Journal on Quality and Patient Safety.
Saul N. Weingart, M.D., Ph.D., from Tufts Medical Center in Boston, and colleagues identified 438 patients with rectal bleeding from 10 Boston adult primary care practices. Physician reviewers assessed the overall quality of care and key care processes following nurse chart abstraction. They examined the correlation of process failures with overall quality and guideline concordance.
The researchers judged the overall quality of care to be good or excellent in 77 percent of cases; however, in the workup of rectal bleeding, 71 percent of patients experienced at least one process-of-care failure. Clinicians failed to obtain an adequate family history, complete a pertinent physical exam, and order laboratory tests in 38, 23, and 16 percent of cases, respectively. The odds of poor or fair care were increased in association with failure to order or perform tests, or to make follow-up plans. There was little correlation between guideline concordance and quality judgements. One hundred twenty-eight delays could have been reduced or prevented.
"Educating practitioners and creating systems to ensure adequate history taking, physical examination, and processes for ordering, performing, and interpreting diagnostic tests may improve performance," the authors write.
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