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Chiropractic Research Review

The Clinical Audit as a Means of Improving Practice

Clinical guidelines are systematically developed statements, typically created through application of literature and endorsement from the chiropractic profession. Guidelines can improve patient care and quality of service, reduce health care costs, and provide a means for educating doctors in the field.

Guidelines can also aid the clinician in the decision-making process.

The clinical audit is a systematic comparison of current practice against explicit clinical guidelines, and can be a valuable tool in quantifying aspects of clinical care. The clinical audit compares established guidelines to what is occurring in the day-to-day operations of clinical practice. Through feedback from the audit, the practicing doctor can make modifications to improve practice procedures to meet currently accepted practice guidelines. The clinical audit can then be performed again to identify if any changes were made.

This study attempted to look at the practice behaviors of the management of temporomandibular joint (TMJ) dysfunction. The records of 10 patients were reviewed, then compared to an unpublished list of TMJ history and examination procedures. Feedback was given to the doctors, and the process was repeated.

Results showed that the feedback modified what the doctors were recording in the patients' files. Thus, clinical audit can be valuable in detecting deficiencies in history-taking and examination procedures. Also, clinical audits indicate an effort to reach higher professional standards.

Although this article makes a good argument for the use of the clinical audit in practice, the methods for development of the suggested clinical guidelines for TMJ dysfunction are in need of improvement.

Hurst H. Audit of case history and examination procedures for the temporo-mandibular joint in clinical chiropractic practice. European Journal of Chiropractic 2001:47, pp. 39-44. Reprints: Tel: 01443 482283; Fax: 01443 483756.

Chiropractic Research Review

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