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Open Access Short report

Peer chart audits: A tool to meet Accreditation Council on Graduate Medical Education (ACGME) competency in practice-based learning and improvement

Lisa J Staton12*, Suzanne M Kraemer2, Sangnya Patel2, Gregg M Talente2 and Carlos A Estrada23

Author Affiliations

1 Department of Internal Medicine, 975 East Third Street Box 94, University of Tennessee College of Medicine-Chattanooga Unit, Chattanooga, TN, USA

2 Division of General Internal Medicine, Department of Medicine at the Brody School of Medicine at East Carolina University, Greenville, NC, USA

3 Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

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Implementation Science 2007, 2:24  doi:10.1186/1748-5908-2-24

Published: 27 July 2007

Abstract

Background

The Accreditation Council on Graduate Medical Education (ACGME) supports chart audit as a method to track competency in Practice-Based Learning and Improvement. We examined whether peer chart audits performed by internal medicine residents were associated with improved documentation of foot care in patients with diabetes mellitus.

Methods

A retrospective electronic chart review was performed on 347 patients with diabetes mellitus cared for by internal medicine residents in a university-based continuity clinic from May 2003 to September 2004. Residents abstracted information pertaining to documentation of foot examinations (neurological, vascular, and skin) from the charts of patients followed by their physician peers. No formal feedback or education was provided.

Results

Significant improvement in the documentation of foot exams was observed over the course of the study. The percentage of patients receiving neurological, vascular, and skin exams increased by 20% (from 13% to 33%) (p = 0.001), 26% (from 45% to 71%) (p < 0.001), and 18% (51%–72%) (p = 0.005), respectively. Similarly, the proportion of patients receiving a well-documented exam which includes all three components – neurological, vascular and skin foot exam – increased over time (6% to 24%, p < 0.001).

Conclusion

Peer chart audits performed by residents in the absence of formal feedback were associated with improved documentation of the foot exam in patients with diabetes mellitus. Although this study suggests that peer chart audits may be an effective tool to improve practice-based learning and documentation of foot care in diabetic patients, evaluating the actual performance of clinical care was beyond the scope of this study and would be better addressed by a randomized controlled trial.