Audit and feedback intervention: An examination of differences in chiropractic record-keeping compliance

Abstract

Objective The objective of this study was to investigate the association of a clinical documentation quality improvement program using audit–feedback with clinical compliance to indicators of quality chart documentation. Methods This was an analysis of differences between adherence to quality indicators of chiropractic record documentation and audit–feedback intervention (feedback report only vs. feedback report with one-on-one educational consultation) at different campuses. Comparisons among groups were analyzed using analysis of variance (ANOVA), Tukey or Dunnett post hoc tests, and Cohen's d effect size estimates. Results There was a significant increase in the mean percentile compliance in 2 of 5 compliance areas and 1 of 11 compliance objectives. Campus B demonstrated significantly higher levels of compliance relative to campus A and/or campus C in 5 of 5 compliance areas and 7 of 11 compliance objectives. Across-campus comparisons indicated that the compliance area Review (Non-Medicare) Treatment Plan [F(2,18) = 17.537, p < .001] and compliance objective Treatment Plan Goals [F(2,26) = 5.653, p < .001] exhibited the highest practical importance for clinical compliance practice. Conclusions Feedback of performance improved compliance to indicators of quality health record documentation, especially when baseline adherence is relatively low. Required educational consultations with clinicians combined with audit–feedback were no more effective at increasing compliance to indicators of quality health record documentation than audit–feedback alone.