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Audits of antibiotic prescribing in a Bristol hospital.

Swindell, P J; Reeves, D S; Bullock, D W; Davies, A J; Spence, C E
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 08/01/1983 EN
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Audits of antibiotic prescribing were done for periods of up to eight weeks in two successive years on medical, surgical, orthopaedic, gynaecology, obstetric, and urology wards and in an accident and emergency department. Clinical details were matched with antibiotic prescribing, and the appropriateness of the latter was judged independently by two medical microbiologists. Only when they agreed was an individual prescription included in the analysis. Overall, 28% of prescriptions in 1979 and 35% in 1980 were judged as unnecessary, with 17% and 16%, respectively, being for inappropriate choices of antibiotic. An educational programme about antibiotic prescribing carried out between the audits had no beneficial effect overall. Though the results compared favourably with those of audits published, prescribing could still be much improved. To judge by the failure of education, however, this might be difficult to achieve. Most prescriptions were written by junior staff, who in the absence of guidance from their seniors and because of their frequent moves would require a widespread and continual education programme. Published concern about the quality of antibiotic prescribing appears to be justified.

Auditing audits: the method of Oxfordshire Medical Audit Advisory Group.

Derry, J; Lawrence, M; Griew, K; Anderson, J; Humphreys, J; Pandher, K S
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 16/11/1991 EN
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OBJECTIVES--To develop a systematic method for both summative and formative audit of practice audits, and to use the method to review Oxfordshire practice audits and to plan improvement. DESIGN--Development of a coding system for the audit cycle subsequently used prospectively to assess audits reported to medical audit advisory group coordinators on practice visits. SETTING--All 85 general practices in Oxfordshire, of which 80 were visited by Oxfordshire Medical Audit Advisory Group coordinators. MAIN OUTCOME MEASURES--Satisfaction of criteria for different levels of audit (full, partial, potential, planning or no audit) according to coding scores for practice audits. RESULTS--46 (58%) practices were classified as doing audit, the remainder doing no audit or only collecting data for family health services authority returns. Of audits being undertaken, 55/102 (54%) included planning care or the setting of targets. CONCLUSIONS--The coding system offers the prospect of formative assessment for practices to help them improve their audits, and summative assessment for the family health services authority to satisfy the needs for professional accountability. Its use in Oxfordshire disclosed considerable deficiencies in the process of practice audit. IMPLICATIONS AND ACTION--Practices in Oxfordshire should improve their audits. The advisory groups target to March 1992 is for 50% of practices to be doing full or partial and 25% potential audit and half of the remainder planning audit. Practices are encouraged to include in their audit implementing change...

Chiropractic audits

Freedman, Allan M
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/2000 EN
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This paper reviews the process which deals with audits of chiropractic billings. It includes the statutory right to review accounts, the factors which lead to a possible audit, the review process itself as well as the possible outcome of a review. Generally, the number of audits performed on professional practices is minimal in relation to the number of practitioners who submit billings for services. Audits are a matter of public necessity involving accountability to the patient and, if government billings are involved, to the public in general. It is incumbent upon the doctor to ensure that proper protocols exist within his or her office to ensure that an audit is nothing more than opening one’s office for an inspection which should satisfy all of the concerned parties as to legitimacy of the practitioner’s entitlement for reimbursement for services rendered.

Can Virtual Streetscape Audits Reliably Replace Physical Streetscape Audits?

Badland, Hannah M.; Opit, Simon; Witten, Karen; Kearns, Robin A.; Mavoa, Suzanne
Fonte: Springer US Publicador: Springer US
Tipo: Artigo de Revista Científica
EN
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There is increasing recognition that the neighborhood-built environment influences health outcomes, such as physical activity behaviors, and technological advancements now provide opportunities to examine the neighborhood streetscape remotely. Accordingly, the aims of this methodological study are to: (1) compare the efficiencies of physically and virtually conducting a streetscape audit within the neighborhood context, and (2) assess the level of agreement between the physical (criterion) and virtual (test) audits. Built environment attributes associated with walking and cycling were audited using the New Zealand Systematic Pedestrian and Cycling Environment Scan (NZ-SPACES) in 48 street segments drawn from four neighborhoods in Auckland, New Zealand. Audits were conducted physically (on-site) and remotely (using Google Street View) in January and February 2010. Time taken to complete the audits, travel mileage, and Internet bandwidth used were also measured. It was quicker to conduct the virtual audits when compared with the physical audits (χ = 115.3 min (virtual), χ = 148.5 min (physical)). In the majority of cases, the physical and virtual audits were within the acceptable levels of agreement (ICC ≥ 0.70) for the variables being assessed. The methodological implication of this study is that Google Street View is a potentially valuable data source for measuring the contextual features of neighborhood streets that likely impact on health outcomes. Overall...

Conducting Community Audits to Evaluate Community Resources for Healthful Lifestyle Behaviors: An Illustration From Rural Eastern North Carolina

McGuirt, Jared T.; Jilcott, Stephanie B.; Vu, Maihan B.; Keyserling, Thomas C.
Fonte: Centers for Disease Control and Prevention Publicador: Centers for Disease Control and Prevention
Tipo: Artigo de Revista Científica
Publicado em 15/10/2011 EN
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A community audit is a qualitative and quantitative research technique in which researchers drive through a community to observe its physical and social attributes, primarily through windshield tours and "ground truthing." Ground truthing is a verification process that uses data gathered by direct observation to corroborate data gathered from secondary sources. Community audits have been used for epidemiologic studies and in program planning for health-promotion interventions. Few studies have detailed the methodology for conducting community audits in rural areas or the extent to which community audits can contribute to an accurate assessment of community characteristics (eg, presence of sidewalks) and nutrition and physical activity resources (eg, produce stands, parks) that may promote healthful lifestyle behaviors. The objective of this article is to describe our approach to conducting a community audit (consisting of windshield tours and ground truthing) to enumerate resources, to assess community characteristics, and to inform revisions to a community guide on nutrition and physical activity resources. We conducted an audit in 10 communities in a rural eastern North Carolina county in 2010. We also collected data from secondary sources to make comparisons with community audit data. The initial resource guide included 42 resources; the community audits identified 38 additional resources. There was moderate to high agreement between windshield tour observations and secondary data sources for several community characteristics...

Serviço Social Audit Saúde no SUS/RN: projeto ético político profissional e de reforma sanitária

Medeiros, Aparecida Dantas de Almeida
Fonte: Universidade Federal do Rio Grande do Norte; BR; UFRN; Programa de Pós-Graduação em Serviço Social; Serviço Social, Formação Profissional, Trabalho e Proteção Social; Serviço Social, Cultura e Relaçõe Publicador: Universidade Federal do Rio Grande do Norte; BR; UFRN; Programa de Pós-Graduação em Serviço Social; Serviço Social, Formação Profissional, Trabalho e Proteção Social; Serviço Social, Cultura e Relaçõe
Tipo: Dissertação Formato: application/pdf
POR
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Health policies in Brazil, the decentralization of SUS management responsibilities for the three spheres of government has driven the creation and regulation of the audits of health services in the National Audit Office, this is a trend of neoliberal policies imposed by international bodies like the World Bank and IMF to peripheral countries characterized by productive restructuring and reforming the state focuses on the presence of two competing projects in the area of health: Health Sector Reform Project which is based on the democratic rule of law with the assumption of health as social right and duty of the State in defending the extension of the conquest of rights and democratization of access to health care guaranteed through the public financing strategies and the effective decentralization of decisions pervaded by social control and privatized Health Project which is based on the state minimum, with a reduction in social spending or in partnerships and privatization, stronger nonprofit sector, subject to capitalist interests, is made effective through strategies targeting health policy and refilantropização actions. In this context, the present study is an analysis on the work of social audits of public health in infants from a qualitative and quantitative approach...

Risk-Based Tax Audits : Approaches and Country Experiences

Khwaja, Munawer Sultan; Awasthi, Rajul; Loeprick, Jan
Fonte: World Bank Publicador: World Bank
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Revenue administration is a major interface between the state and its citizens. A good revenue administration is, therefore, an important attribute of good government. As a result, in recent years, policy makers have become increasingly aware of the importance of policies that will promote business development while ensuring voluntary tax compliance. In the modern context, it is neither desirable nor feasible to examine or inspect every single taxpayer. The revenue administration, therefore, has to rely on effective management of compliance. Promoting voluntary compliance, achieved through a self-assessment system in which taxpayers comply with their tax obligations without intervention from tax officials, requires developing modern approaches to audits based on risk management. The impact of audits critically depends on a properly designed audit selection strategy focused on high-risk taxpayers to provide the most cost-effective outcome. This, in itself, contributes to promoting voluntary compliance. Risk-based country audits: approaches and country experiences are an important study of this critical revenue function of compliance management.

Bridging the Malnutrition Gap with Social Audits and Community Participation

Swain, B.; Sen, P. D.
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Artigo de Revista Científica
EN
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There is an urgent need to increase coverage of the Integrated Child Development Scheme (ICDS) particularly in Madhya Pradesh and to overcome governance failures, such as staff absenteeism, leakage of funds and supplies and false reporting of coverage. By increasing community participation, ownership of the scheme, and improving programme oversight, social audits can result in increased coverage as well as better accountability among service-providers and the relevant line departments. The bulk of experience with social audits comes from implementation of the National Rural Employment Guarantee Act (NREGA), which mandates that social audits be conducted prior to fund release. There is also some experience of using social audits for ICDS in Andhra Pradesh and Orissa. This article examines the experiences from those two states and draws lessons for its application in states such as Madhya Pradesh.

Lithuania : Accounting and Auditing

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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This assessment of accounting and auditing standards and practices in Lithuania was focuses on the strengths and weaknesses of the institutional arrangements needed to observe International Accounting Standards (IAS) and International Standards on Auditing (ISA). Financial reporting and accounting by Lithuanian enterprises are currently governed by laws and other regulations issued in 1992 and 1993. New laws that came into effect in 2002 will significantly increase conformity between Lithuanian requirements and European Union (EU) Directives, establish a new national standard-setting body, and require greater compliance with IAS. There is a risk, therefore, that banks may be unable to fully comply with IAS because of conflicting requirements under national bank (BOL) regulations. While the quality of many of the IAS financial statements reviewed was good, there were a number of possible conflicts resulting from the application of BOL regulations and other circumstances peculiar to Lithuania. There is currently no enforcement or monitoring of compliance with IAS or national standards. The audit of financial statements must be carried out by qualified auditors and in accordance with Lithuanian standards that are based on ISA. While many audit firms make strenuous efforts to carry out audits in accordance with ISA...

Kyrgyz Republic : Country Financial Accountability Assessment

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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This report has identified the following major issues in the public sector financial accountability of the Kyrgyz Republic: 1) weak internal controls in several areas such as treasury, budget implementation, procurement, human resources, accounting and reporting as evidenced by large amounts o f illegal unintended expenditures, embezzlements and other financial offences reported by the external auditor; 2) weak cash management as the treasury cash rations on a day-to-day basis, which creates uncertainty for budget institutions in implementing their plans; 3) absence of a legal basis for internal audit in the public sector; 4) weak capacity in the C A for carrying out effective financial audits and focusing attention on the basis of risk assessment; 5) weak capacity in line ministries to undertake systematic budgeting exercise; 6) budget monitoring is limited to monitoring of fiscal targets as little attention is paid to assessment of program effectiveness; 6) lack of systematic management accounting and weak capacity in departmental management to absorb and use management accounting data in decision making and management processes; 7) weak capacity in the parliamentary committees to provide effective legislative oversight over the executive; and 8) inadequate accountability arrangements for public enterprises. Key Recommendations offered in the short term involve: 1) strengthening internal controls and the treasury cash management function; 2) establishing daily reconciliation of consolidated district treasury payment requests; 3) reconciling daily revenue collections; and 4) granting authority to the Chamber of Accounts (CA) to perform interim post audits. In the long term the Government should: 1) enact the Law on Public Sector Internal Audit and build internal audit capacity; 2) establish effective internal audit structures in the line ministries; 3) prepare rules and methodology for conducting internal audits in the public sector; 4) provide extensive training; 5) require internal auditors to carry out detailed assessments of internal controls; 6) require the CA to certify the year-end financial statements of the government; 7) make the process of appointment of the Chairman of the CA transparent; 8) discontinue the special means provisions; and 9) clearly define the accountability of public enterprises.

A structured framework for improving outbreak investigation audits

Dalton, Craig; Merritt, Tony D; Durrheim, David N; Munnoch, Sally; Kirk, Martyn
Fonte: http://www.biomedcentral.com/ Publicador: http://www.biomedcentral.com/
Tipo: Journal article; Published Version; BioMed Central Ltd Formato: 8 pages
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BACKGROUND: Outbreak investigation is a core function of public health agencies. Suboptimal outbreak investigation endangers both public health and agency reputations. While audits of clinical medical and nursing practice are conducted as part of continuous quality improvement, public health agencies rarely make systematic use of structured audits to ensure best practice for outbreak responses, and there is limited guidance or policy to guide outbreak audit. METHODS: A framework for prioritising which outbreak investigations to audit, an approach for conducting a successful audit, and a template for audit trigger questions was developed and trialled in four foodborne outbreaks and a respiratory disease outbreak in Australia. RESULTS: The following issues were identified across several structured audits: the need for clear definitions of roles and responsibilities both within and between agencies, improved communication between agencies and with external stakeholders involved in outbreaks, and the need for development of performance standards in outbreak investigations - particularly in relation to timeliness of response. Participants considered the audit process and methodology to be clear, useful, and non-threatening. Most audits can be conducted within two to three hours...

Expanding the Navy’s Managers’ Internal Control Program’s (MICP) capability to prepare for external financial audits

Pagnucco, Jonathan P.
Fonte: Monterey, California: Naval Postgraduate School Publicador: Monterey, California: Naval Postgraduate School
Tipo: Tese de Doutorado
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Approved for public release; distribution is unlimited; The Department of the Navy’s Managers’ Internal Control Program (MICP) is an important tool for ensuring the Department is well managed. In 2013, The Committee of Sponsoring Organizations of the Treadway Commission (COSO) added 17 principles to the five existing internal control components. In 2014, the Government Accountability Office’s (GAO) updated the Standards for Internal Control in the Federal Government and directed federal managers to adopt the update by fiscal year 2016. The Navy’s internal control program does not yet comply. After analyzing the content of the MICP against the COSO and GAO publications, this thesis developed templates to supplement the MICP in order to bring the Navy program into compliance and provide a tool for internal assessment that may aid commands as they prepare for external financial audits.; ; Lieutenant, United States Navy

Activating Social Audits in Orissa

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Procurement Study; Economic & Sector Work
ENGLISH; EN_US
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With the passing of the National Rural Employment Act (NREGA) in 2005, the Government of India established a landmark provision that enables communities to act as watchdogs on local level implementation of the Government's flagship anti-poverty program. While the concept of 'social audits' builds on a great deal of experience in the country, the provisions in the Act have not been translated into clear guidelines. As a result, social audits of NREGA have tended to be driven through 'high impact' approaches led by civil society organizations and have been focused on exposing malpractice rather than improving implementation. This paper discusses an initiative by the centre for youth and social development which sought to explore options to activate the social audit process in Orissa. The design draws on the provisions of the Act with a view to developing a sustainable model for the state. The pilot was conducted in six gram panchayats where the various stages of preparation, committee formation, auditing and reporting were developed. The paper highlights the importance of social audits as an instrument to support implementation...

Incentive Audits : A New Approach to Financial Regulation

Čihák, Martin; Demirgüç-Kunt, Aslı; Johnston, R. Barry
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Policy Research Working Paper; Publications & Research
ENGLISH; EN_US
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A large body of evidence points to misaligned incentives as having a key role in the run-up to the global financial crisis. These include bank managers' incentives to boost short-term profits and create banks that are "too big to fail," regulators' incentives to forebear and withhold information from other regulators in stressful times, and credit rating agencies' incentives to keep issuing high ratings for subprime assets. As part of the response to the crisis, policymakers and regulators also attempted to address some incentive issues, but various outside observers have criticized the response for being insufficient. This paper proposes a pragmatic approach to re-orienting financial regulation to have at its core the objective of addressing incentives on an ongoing basis. Specifically, the paper proposes "incentive audits" as a tool that could help in identifying incentive misalignments in the financial sector. The paper illustrates how such audits could be implemented in practice, and what the implications would be for the design of policies and frameworks to mitigate systemic risks.

Social Audits in Nepal's Community Schools : Measuring Policy Against Practice

Prasad Kafle, Agni; Patel, Darshana; Agarwal, Sanjay
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Brief
ENGLISH; EN_US
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Nepal s publicly-funded schools have been managed by community-level stakeholders since 1950 when Nepal first adopted a demo¬cratic system of government. Subsequent changes to legislation and policy have further devolved school management to the com¬munity level, including the provision of financial resources to support decision making by school-level committees. In addition to these reforms, each community school is now required to conduct an annual social audit. Community School National Network (CSNN), a national Nepali NGO with expertise in social accountability approaches, conducted a pilot of 60 schools in three districts (Kaski, Dolakha, and Nawalparasi) to assess gaps in the implementation of social audits by schools as specified in the Guidelines for the Social Auditing of the Schools issued by the Ministry of Education (MoE) of the Government of Nepal. In each of the three districts studied, 70 80 percent of the entire school budget is community-funded. Approximately 83 percent of community schools conducted social audits in the academic year 2008 09. Their implementation varied between the three districts but gaps were usu¬ally due to poor capacity and lack of information about community-level responsibilities. CSNN led a capacity-building initiative at the national...

La responsabilité sociale des entreprises transnationales : études de cas sur les audits sociaux et les droits des travailleurs en Chine

Hamelin, Mathieu
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
FR
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À l’heure actuelle, la régulation des chaines mondiales de production dépend principalement de mécanismes non étatiques tels que les codes de conduite et les audits sociaux implantés par les entreprises, les ONG et les organisations internationales. Dans cette recherche, nous évaluons si les audits menés par Nike, Adidas et Puma peuvent contribuer à renforcer les droits des travailleurs chinois. À l’aide d’entrevues réalisées sur le terrain auprès d’auditeurs et d’ONG, nous avons conceptualisé quatre conditions de base, lesquelles concernent la participation directe des travailleurs, le développement de capacités locales, le respect de la liberté d’association et la professionnalisation du travail d’auditeur social. Notre étude conclut que des étapes restent à franchir afin que les audits deviennent des outils d’avancement des droits fondamentaux. L’enjeu prioritaire demeure le développement de structures démocratiques afin de permettre aux ouvriers de former des syndicats libres et de négocier leurs propres conventions de travail.; Current regulation of global supply chains mainly relies on non state mechanisms such as codes of conduct and social audits implemented by corporations, non governmental organizations (NGOs) and international organizations. This research seeks to assess if the audits carried out by Nike...

Évaluation de stratégies pour améliorer l'observance de la biosécurité sur les fermes avicoles au Québec

Racicot, Manon
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
FR
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La problématique de l’observance de la biosécurité est présente dans tous les types de production. Il est essentiel de définir des stratégies pour améliorer l’application des mesures de biosécurité. Cette étude décrit l’application des mesures de biosécurité à l’entrée et à la sortie de 24 bâtiments d’élevages avicoles au Québec, Canada. L’effet des audits et de caméras visibles sur l’observance a été étudié, de même que les déterminants de l’observance. De plus, la relation entre l’observance et les profils de personnalité, l’expérience et l’éducation a été décrite. L’application des mesures de biosécurité a été évaluée à l’aide de caméras cachées. L’observance à court terme (deux premières semaines) et à moyen terme (six mois plus tard) a été déterminée. Basés sur les résultats du groupe contrôle, 44 différentes erreurs lors de l’application des mesures de biosécurité ont été observées à l’entrée et la sortie des bâtiments. La plupart étaient reliées à la délimitation des zones (propre versus contaminée). La nature et la fréquence des erreurs suggèrent un manque de compréhension des principes associés aux mesures de biosécurité. Le visionnement des vidéos a révélé 3055 visites par 277 individus différents (136 employés...

Auditing audits: use and development of the Oxfordshire Medical Audit Advisory Group rating system.

Lawrence, M.; Griew, K.; Derry, J.; Anderson, J.; Humphreys, J.
Fonte: BMJ Group Publicador: BMJ Group
Tipo: Artigo de Revista Científica
Publicado em 20/08/1994 EN
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OBJECTIVES--To assess the value of the Oxfordshire Medical Audit Advisory Group rating system in monitoring and stimulating audit activity, and to implement a development of the system. DESIGN--Use of the rating system for assessment of practice audits on three annual visits in Oxfordshire; development and use of an "audit grid" as a refinement of the system; questionnaire to all medical audit advisory groups in England and Wales. SETTING--All 85 general practices in Oxfordshire; all 95 medical audit advisory groups in England and Wales. MAIN OUTCOME MEASURES--Level of practices' audit activity as measured by rating scale and grid. Use of scale nationally together with perceptions of strengths and weaknesses as perceived by chairs of medical audit advisory groups. RESULTS--After one year Oxfordshire practices more than attained the target standards set in 1991, with 72% doing audit involving setting target standards or implementing change; by 1993 this had risen to 78%. Most audits were confined to chronic disease management, preventive care, and appointments. 38 of 92 medical audit advisory groups used the Oxfordshire group's rating scale. Its main weaknesses were insensitivity in assessing the quality of audits and failure to measure team involvement. CONCLUSIONS--The rating system is effective educationally in helping practices improve and summatively for providing feedback to family health service authorities. The grid showed up weakness in the breadth of audit topics studied. IMPLICATIONS AND ACTION--Oxfordshire practices achieved targets set for 1991-2 but need to broaden the scope of their audits and the topics studied. The advisory group's targets for 1994-5 are for 50% of practices to achieve an audit in each of the areas of clinical care...

Implementing Risk-Limiting Post-Election Audits in California

Hall, Joseph Lorenzo; Miratrix, Luke W.; Stark, Philip B.; Briones, Melvin; Ginnold, Elaine; Oakley, Freddie; Peaden, Martin; Pellerin, Gail; Stanionis, Tom; Webber, Tricia
Fonte: Universidade Cornell Publicador: Universidade Cornell
Tipo: Artigo de Revista Científica
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Risk-limiting post-election audits limit the chance of certifying an electoral outcome if the outcome is not what a full hand count would show. Building on previous work, we report on pilot risk-limiting audits in four elections during 2008 in three California counties: one during the February 2008 Primary Election in Marin County and three during the November 2008 General Elections in Marin, Santa Cruz and Yolo Counties. We explain what makes an audit risk-limiting and how existing and proposed laws fall short. We discuss the differences among our four pilot audits. We identify challenges to practical, efficient risk-limiting audits and conclude that current approaches are too complex to be used routinely on a large scale. One important logistical bottleneck is the difficulty of exporting data from commercial election management systems in a format amenable to audit calculations. Finally, we propose a bare-bones risk-limiting audit that is less efficient than these pilot audits, but avoids many practical problems.; Comment: Accepted to the Electronic Voting Technology Workshop/Workshop on Trustworthy Elections 2009 (EVT/WOTE '09), http://www.usenix.org/events/evtwote09/

Quality-of-care audits and perinatal mortality in South Africa

Allanson,Emma R; Pattinson,Robert C
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2015 EN
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AbstractProblem Suboptimal care contributes to perinatal mortality rates. Quality-of-care audits can be used to identify and change suboptimal care, but it is not known if such audits have reduced perinatal mortality in South Africa.Approach We investigated perinatal mortality trends in health facilities that had completed at least five years of quality-of-care audits. In a subset of facilities that began audits from 2006, we analysed modifiable factors that may have contributed to perinatal deaths.Local setting Since the 1990s, the perinatal problem identification programme has performed quality-of-care audits in South Africa to record perinatal deaths, identify modifiable factors and motivate change.Relevant changes Five years of continuous audits were available for 163 facilities. Perinatal mortality rates decreased in 48 facilities (29%) and increased in 52 (32%). Among the subset of facilities that began audits in 2006, there was a decrease in perinatal mortality of 30% (16/54) but an increase in 35% (19/54). Facilities with increasing perinatal mortality were more likely to identify the following contributing factors: patient delay in seeking help when a baby was ill (odds ratio, OR: 4.67; 95% confidence interval, CI: 1.99-10.97); lack of use of antenatal steroids (OR: 9.57; 95% CI: 2.97-30.81); lack of nursing personnel (OR: 2.67; 95% CI: 1.34-5.33); fetal distress not detected antepartum when the fetus is monitored (OR: 2.92; 95% CI: 1.47-5.8) and poor progress in labour with incorrect interpretation of the partogram (OR: 2.77; 95% CI: 1.43-5.34).Lessons learnt Quality-of-care audits were not shown to improve perinatal mortality in this study.