Clinical Practice Audit (CPA) Project
The Clinical Practice Audit (CPA) answers the question, “How well am I doing?” It is a
simple exercise you can do to see if you are providing the best standard of care for your
patients. This exercise is usually done by reviewing a random sample of patient charts,
takes very little time and can lead to improvements in the quality of your patient care.
Clinical practice audit (CPA) is an activity recognized by the College of Family
Physicians of Canada as a necessary skill for family doctors. This skill should be learned
and applied during residency training. It is concerned with improving processes and
reducing variation so that everyone‟s performance progressively improves.1 Residents in
family practice block time have a close working relationship with their preceptors, which
provides an ideal opportunity for collegial project development.
To develop skills in clinical practice audit.
to practice critical appraisal skills
To carry out this project in partnership with and in harmony with a practice preceptor.
To improve the quality of patient care.
To identify a practice-based clinical problem and gather and appraise a sample of
the background literature.
To apply evidence-based information to the development of a clinical audit and use it
to assess patient care in the practice setting.
To explore the results with the practice preceptor and establish recommendations
jointly. The results and the information gained are to be held in confidence between
the preceptor and the resident unless they agree to wider dissemination.
1. Identify a clinical problem that interests you.
2. Discuss your choice with your preceptor or supervisor.
3. Do a literature search and identify and critically appraise about three important
articles in the subject area.
4. Determine the standard of care to which you will compare your practice
5. Create an audit form (or electronic spreadsheet) for data collection
6. Review at least 12 charts. (See below for some different ways to choose charts
randomly. This is VERY important!)
7. Review the charts and extract the data onto your audit form (or electronic
8. Calculate and answer your questions using simple percentages, averages, etc.
(There is no need to do tests of statistical significance.)
9. Review the results with your preceptor and develop joint recommendations.
10. Write a brief CPA report (see how to write a CPA report below)
11. Email your written report to your site administrator (or your site research lead
HOW TO WRITE A CPA REPORT:
Write a brief report, no more than 3-4 pages, and include the following:
explain why you chose your clinical problem
clearly state your question
summarize the literature (3 or more articles) about your subject area
(i.e. outline the standard of care based on the evidence in the
literature): see „literature searching’ on the „How to do research‟ web
page at http://www.familypractice.ubc.ca/. (click on education, then
click on Postgraduate Education, scroll down to research, click on
how to do research, then literature searching.)
You are expected to critically appraise these articles: see ‘critical
appraisal’ on the „How to do research‟ web page at
http://www.familypractice.ubc.ca/ (click on research, scroll down to
explain how your audit form (data collection sheet) was developed
include a copy of data collection sheet with your report
outline how many charts you selected and how they were selected
(they should be selected in a non-biased manner)
summarize your findings
discuss possible reasons for your findings
discuss how well you and your preceptor are doing compared with the
standard of care outlined in the literature
document collegial involvement with your preceptor
make recommendations for your practice (i.e. outline how you could
reference key articles
CPA PROJECT TIMELINES:
The CPA will take place in the first year of the program. It can be done retrospectively or
prospectively. Please consult your site administrator (or your site research lead faculty)
regarding the deadline for handing in your completed report. At SPH, the CPA project
is due at the end of January in your first year.
Research Services at UBC has given ethical approval for CPA projects as a group. It is
fundamental to our role as physicians that we do no harm and maintain a great respect
for patient confidentiality. Collection of information through chart audit needs to respect
these principles. Audit forms must be anonymous. It is also essential to respect the
collegial educational relationship between preceptor and resident, which will allow for
optimal learning from this activity. If you have any questions about the process or
program expectations please contact your site lead research faculty , or the residency
program lead faculty for research.
Headrick LA, Neuhauser D, Schwab P, Stevens DP. Continuous quality improvement
and the education of the generalist physician. Acad Med Supp 1995; 70(1):104-109.
Godwin, Marshall “Conducting a clinical practice audit: Fourteen steps to better
patient care” Canadian Family Physician VOL 47: Nov 2001 p 2331
Obtaining a random sample of charts:
The more random your chart selection is, the more likely your results are going to
be truly representative of all the patients in your practice. Good randomization
enables you to achieve valid information with small sample sizes. The following
are some methods of obtaining random samples:
If reviewing all patients:
1. Every nth chart on the shelf
2. Every nth patient on a list of all patients
If reviewing patients with a specific problem or disease:
1. Every nth patient from a list of ALL patients with the disease
2. Random sample using random number generator on the list of ALL patients
with the disease
Please note that sampling patients within a scheduling time-frame (eg: all
diabetics seen in the last month) is biased towards seeing the sicker, more
complicated patients who visit more often.