2.  CHART AUDITS FOR QUALITY ASSESSMENT AND IMPROVEMENT ACTIVITIES

For any facility to provide quality diabetes care, on-going self-assessment and improvement activities are necessary. A number of techniques or methods to pursue improvement may be employed. A central feature of each of these systems is some form of an improvement cycle:

	Surveillance
Implementation		Identification of a problem
	Plan for improvement

With respect to diabetes, the basic questions to be answered are straightforward: "Are we doing those things that we agreed were important for maximizing the health of our patients with diabetes?" and "Are there ways that we could do better?" Getting accurate and reliable answers is more complex, of course, but the diabetes audit program is designed to make it easier to do just that.

The IHS Diabetes Program recommends annual or more frequent medical record review to monitor care patterns and changes over time at your facility. You should select in a random manner a large enough sample of medical records so that you can be reasonably certain that observed changes are significant and not just due to chance.  All of the indicators on the audit form, which reflect compliance with the Standards of Care for Patients with Type 2 Diabetes, should be completed as outlined in section 7.

The staff at your facility may be asked to participate in the audit process. While this process may seem tedious at first, many providers have found that participating in the chart audit provides a review of the standards of care for diabetes and identifies trends in diabetes care at their facility. Through the audit, the providers often have a better idea of what changes they can make to improve the outcome for people who suffer from this potentially devastating disease.

Once the chart audit is complete, the data may be entered into the Epi Info program, from which you can immediately print a summary report. The report shows the percentage of charts having documentation of compliance with each of the indicators. Your Area Diabetes Consultant can assist you in obtaining reports and comparison data. In addition, your Area Diabetes Consultant can assist you in identifying program strengths and deficiencies. Facilities are encouraged to review the recommendations in a team setting, establish priorities together, and develop an action plan with a timetable for re-evaluation.