Research or Audit?

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Research or Audit?

• Nina Dunham
• RD Manager

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Introduction

• What is Research?
• What is Audit?
• Why Research Audit get confused?
• How the Trust processes research audit

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Research

• A systematic investigation undertaken to discover
  facts or relationships and reach conclusions
  using scientifically sound methods.
• (Hockey, 1996)

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Research

• Purpose To provide new knowledge in order to
  set or change standards
• Methods Randomised Trials etc
• Data Analysis Extensive statistical analysis
• Ethical Trust Approval Always required
• Sample size statistically powered calculation

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Research

• Significance Statistical difference (hypothesis
  driven)
• Outcome Improve knowledge
• Results, publications Generalisable,
  publishable in peer reviewed journals
• Findings influence clinical practice as a whole

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Example of Research

• Purpose comparing recovery rates in surgical
  procedure A compared to surgical procedure B in
  patients with diabetes over the age of 65
• Method Randomised Clinical Trial (RCT)
• Data Analysis Statistical analysis
• Sample size n statistically powered
  calculation
• Significance statistical p value

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Example of Research

• Outcome Emperical Data which can be compared to
  existing knowledge and utilised in the decision
  making to use surgical procedure A as opposed to
  B
• Results Generalisable, results can influence
  clinical practice as a whole, accepted and
  published in peer reviewed medical journals

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Audit

• A quality improvement process that seeks to
  improve patient care and outcomes -through
  systematic review of care - against explicit
  criteria and the implementation of change (NICE
  2003)

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Audit

• Audits are cyclical ie completion of audit
  cycle includes identifying areas of
  non-conformity with evidence based standards
  implementing practice changes to address these
  and then re-auditing standards of care

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Audit

• Purpose Tests conformity with evidence based
  standards
• Methods Never involves allocation to different
  treatment groups
• Data analysis Simple statistical analysis eg
  descriptive and unadjusted comparisons such as
  t-tests
• Ethic approval not necessarily required

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Audit

• Sample size sufficiently large case number to
  influence practice based on audit findings
• Significance Clinically meaningful performance
  indicators set against standards
• Outcome Improved clinical practice
• Results Audit methods and findings are usually
  locally implemented

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Example of Audit

• Purpose Surgical procedure A is recognised as a
  gold standard for patients over the age of 65
  with diabetes
• Method Case note review
• Data Analysis Percentage of cases reviewed
  which meet the criteria
• Sample size not statistically powered

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Example of Audit

• Significant acceptable adherence threshold may
  be set 100, 90 or 80 dependent on practice
  being audited
• Outcome improved clinical practice
• Results Relevant to designated setting. Audit
  methods and findings may be of wider interested
  to be published.

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Similarities between Research Audit

• Research audit involve answering a specific
  question relating to quality of care
• Both can be carried out either prospectively or
  retrospectively
• Both involve careful sampling, questionnaire
  design and analysis of findings
• Both activities should be professionally led

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How the Trust processes Research Audit

• The NHS clinical effectiveness initiative
  explicitly links research and clinical audit,
• without research we wont know what clinically
  effective practice is
• without audit we wont know whether it is being
  practised

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How the Trust process Research Audit

• In order to conform with the Research Governance
  Framework all research projects must have Ethical
  Trust approval
• All Audit projects have to be processed through
  the Audit department using the CG1 form

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How the Trust process Research Audit

• What happens when there is a difference of
  opinion?
• Discussion between Ethics, Research Audit dept
• Research Executive Group
• Medical Director

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Further Information

• Research Dept RD Admin Porta Cabin, CHH
• Research Staff
• Intranet Pages
• Audit Dept Hull Royal Infirmary
• Audit Staff
• Intranet Pages
• University Web Site

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Conclusion

• What is Research?
• What is Audit?
• Why Research Audit get confused?
• How the Trust processes research audit
• Where to find further information