Research vs Audit

scrubscourses interview workshop

 Objectives
By the end of this session,
participants should be able to
Clearly define research and audit
Distinguish the similarities and
differences between research and
audit
Learn the stages involved in an audit
cycle
scrubscourses interview workshop
2013
 Research
'a structured activity which is
intended to provide new knowledge
which is generalisable (i.e. of value
to others in a similar situation) and
intended for wider dissemination '
Department of Health, 2002

scrubscourses interview workshop

2013
 Research
The underlying aim is to create new
knowledge
Tests new treatments
Assists in developing new standards
of care
It facilitates evidence based
medicine

scrubscourses interview workshop

2013
 Clinical Audit
'a quality improvement process that seeks to
improve patient care and outcomes through
systematic review of care against explicit
criteria and the implementation of change.
Aspects of the structure, processes and
outcomes of care are selected and
systematically evaluated against explicit
criteria. Where indicated, changes are
implemented at an individual, team, or
service level and further monitoring is used to
confirm improvement in healthcare delivery. '
(Principles for Best Practice in Clinical Audit,
NICE, 2002)
scrubscourses interview workshop
2013
 Clinical Audit
Quality assurance process
Assesses whether we are adhering to
best practice and agreed guidelines
Adapt current practice to be in line
with best practice

scrubscourses interview workshop

2013
 Similarities
Both involve answering a specific
question relating to quality of care
Both can be carried out either
prospectively or retrospectively
Both involve careful sampling,
questionnaire design and analysis of
findings, presentation

scrubscourses interview workshop

2013
 Differences - 1
Research creates new knowledge; clinical audit tells us if we
are following best practice.

Research is based on a hypothesis; clinical audit measures

against standards.

Research is a ONE off process & theory driven: Audit is

continuous & practice driven

Research can involve patients trying an untested treatment

method; degree of experimentation on patients, may involve
allocating patients to different treatment groups: clinical
audit never involves patients trying new treatment methods.

Research OFTEN based on a scientifically valid sample size;

clinical audit sample sizes not important for statistical
significance.

scrubscourses interview workshop

2013
 Differences - 2
Research may involve some detailed statistical analysis of the
collected data; clinical audit requires only basic statistic
analysis

Results from research CAN be generalised and therefore have

a wider implication on clinical practice; clinical audit results
are applicable within local settings only but can be shared.

Research involving NHS staff, patients, tissue samples

requires ethics committee approval; clinical audit rarely
requires ethics approval

Research may not be conducted by those in service provision;

audit mostly is.

scrubscourses interview workshop

2013
Stages of a Clinical Audit
Cycle

scrubscourses interview workshop

2013
RESEARCH

AUDIT
scrubscourses interview workshop
2013
Questions?
scrubscourses interview workshop
2013
Types of Studies

scrubscourses interview workshop

2010
 Types of Studies
Interventional aka Randomised
Controlled Trials (RCT)
Case-control Studies
Cohort Studies
Systematic Reviews
Ecological Studies
Cross sectional studies

scrubscourses interview workshop

2013
scrubscourses interview workshop
2013
 RCT
GROUP A
E
NEW TREATMENT
V
PATIENT E
POOL N
GROUP B
T
ESTABLISHED /
PLACEBO S

T I M E

Prospective Study
scrubscourses interview workshop
2013
 RCT
Advantages
Best method to compare effectiveness
of different treatments
Randomised
Open / Single blinded / Double Blinded

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2013
 RCT
Disadvantages
Expensive
Time consuming
Confounding factors
Bias
Bad for rare diseases
Ethical Approval?

scrubscourses interview workshop

2013
 Case-Control Study
Advantages
Good for diseases with long latency
Good for rare diseases
Easy to recruit
Quick
Cheap
Potentially look at multiple disease
causes

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2013
 Case-Control Study
Disadvantages
Recall bias
Confounding
Relationship may not be true
Choice of control group may be difficult

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2013
 Cohort Study
GROUP
EXPOSED RESULT
OF
INTEREST
COMPARE

COMPARISON RESULT
NON EXPOSED
GROUP

T I M E

Prospective
RELATIVE RISK

scrubscourses interview workshop

2013
 Cohort Study
Advantages
Reduces bias
Bad for rare diseases
Potential to look at multiple causal
factors

scrubscourses interview workshop

2013
 Cohort Study
Disadvantages
Expensive
Time consuming
- Exposure patterns and population can
change over time

scrubscourses interview workshop

2013
 Systematic Reviews
Uses many similar studies published
in order to pool data together
Adv: lots of data
may be more accurate
Dis: publication bias eg only english
papers
not all studies are combinable
quality of studies?
scrubscourses interview workshop
2013
 Questions ?

scrubscourses interview workshop

2013