The definition of quality within our eye practice often seems illogical or anachronistic with a reliance more on documentation than performance or outcome or even relevance. While such compliance is necessary for continued practice and participation in those programs it tells little whether we are doing the job you believe you should be doing.
Quality assurance is a broad issue, but the Institute of Medicine’s “Crossing the Quality Chasm” (2002, National Academy Press) outlines three steps.
The first of these is currency of medical information. While most doctors receive their information through continuing education lectures at conferences or schools, it cannot be their sole source. Lectures can sometimes be a reemphasis of standard or customary treatment that may not reflect new research. On the other hand, journal articles are much or current and receive peer review for its rigor and impartiality.
Secondly, synthesizing a clinical practice from what you read requires an evaluation by the doctor or a third party that the literature is sound even though the articles are peer reviewed. One such third party is the Cochrane Collaboration (http:// http://www.cochrane.org/ ) whose sole purpose is “…to help health care providers, policy makers, patients, their advocates and [caregivers], make well-informed decisions about health care, based on the best available research evidence, by preparing, updating and promoting the accessibility of Cochrane Reviews )…” Individually, doctors can join journal clubs or chat with colleagues, but rarely can such synthesis be done in isolation
Lastly, applying what you have learned into a practice guideline that works for you. Although national organizations have proposed practice guidelines in optometry, adopting them may be expeditious, but unworkable if enabled in their entirety due to the doctor’s own practice style or environment. An iteration of a public guideline is practical and easy-to-do and justifiable even if it deviates just a little bit.
In conclusion, medical quality assurance is more than documentation or “filling-the-blanks/boxes.” It is an active and ongoing approach that will fulfill the hope and promise of optometry to its patients.
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