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Can you use a sequential sample of patients as a substitute for a full practice audit?

Study of mammography screening rates in 20 family practices in Ontario

Janusz Kaczorowski, MA PhD
Professor and Research Director in the Department of Family Practice at the University of British Columbia in Vancouver

Correspondence: Dr Graham Swanson, 2238 Caroline St, Burlington, ON L7R 1M6; e-mailswansong{at}mcmaster.ca

OBJECTIVE To compare rates of mammography screening among women in family practices, based on a sequential sample of eligible women presenting to the practices during an 8-week period, with rates found in a full audit of all eligible patients.

DESIGN Chart review.

SETTING Twenty community-based family practices in south-central Ontario.

PARTICIPANTS Family physicians and their female patients 52 to 71 years old who had had at least 1 visit to the office during the past 3 years.

INTERVENTION Eligible patients were sampled by 2 approaches: sequential sampling of patients coming for appointments during an 8-week period and a full practice audit of all eligible women.

MAIN OUTCOME MEASURE Mammography rates found using the 2 approaches.

RESULTS The mean time-appropriate rate of mammography screening based on the sequential sample was 66.4%. The mean time-appropriate rate of mammography screening for the full practice audit was 58.8%. The sequential sample rate was higher than that of the full audit by 7.6%; differences ranged from –6.5% to 24.9% among practices. Regression analysis indicated a positive and significant correlation between rates based on the data generated by the 2 different approaches (r² = 0.50).

CONCLUSION A rate of mammography screening based on a sequential sample can reasonably approximate the actual rate of mammography screening that would be found based on a full practice audit.