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 Division of Diabetes recommends annual or more frequent medical record review to monitor care patterns and changes over time at your facility.  Those performing electronic audits are encouraged to include ALL of their active diabetes patients in the review.  Manual auditors should select in a random manner a large enough sample of medical records to be reasonably certain that observed changes are significant and not just due to chance (see sections 4 and 5).  Facilities are encouraged to review the audit reports in a team setting, establish priorities together, and develop an action plan with a timetable for re-evaluation.