Follow-up Audit Research Articles

Nurse-led speech therapist referral initiative for older adult patients at risk of dysphagia: a best practice implementation project.

Dysphagia is common among older patients, affecting their nutritional status, hospital readmission, length of hospital stay, and hospitalization costs. Nurses can play a key role in early identification of dysphagia through systematic screening. This project sought to (i) achieve 80% compliance among nurses in using the 4-point questionnaire test (4QT) swallow screening test on patients and (ii) ensure all patients screening positive for dysphagia were referred to a speech therapist within 1 day. A short swallow screening tool was adapted from an evidence-based screening tool, the 4QT, by a team of speech therapists, a geriatrician, and a geriatric trained nurse. Ward nurses were then trained on using the tool to screen older patients upon admission or transfer to another ward. The project used the JBI Evidence Implementation Framework, which involved pre and post audits and feedback to evaluate compliance with best practice. Compliance increased in the use of the short swallow screening tool, rising from 64% ( n = 25) in the baseline audit to 71% ( n = 34) in the follow-up audit. However, there was a decrease in the referral of patients who screened positive for dysphagia to speech therapists, with the rate dropping from 92% ( n = 12) to 86% ( n = 12). All patients ( n = 12) from both baseline and follow-up audits were referred to a speech therapist within 1 day of admission/transfer post-implementation compared with 70% ( n = 7) at pre-implementation. This project applied evidence-based recommendations to clinical practice and improved patient outcomes. The nurses facilitated timely referrals to speech therapists for further assessment and intervention, which was useful in the clinical context. The nurses continue to use the screening tool routinely to prevent dysphagia complications among geriatric patients.

Pain assessment and management among adult patients in a gynecology ward: a best practice implementation project.

This project aimed to improve compliance with evidence-based practice in pain assessment and management in a gynecology ward. Effective pain control is important to prevent the negative consequences of pain that is poorly managed. However, it remains undervalued and inadequately treated. Applying evidence-based practices to correctly evaluate and manage pain is essential to improve pain relief. This project followed the JBI Evidence Implementation Framework. A baseline audit of 41 women admitted to the gynecology ward was conducted and measured against 5 best practice criteria, along with a patient satisfaction questionnaire. Targeted strategies were then implemented and a follow-up audit was conducted using the same criteria, methods, and sample size as the baseline audit. The baseline audit revealed gaps between current and best practice. Barriers to implementation were identified and strategies to resolve the barriers were designed and implemented (nurse education, informative materials, electronic patient records system improvements). Comprehensive pain assessment, including dynamic and static pain assessment, use of a validated tool, and education provided to patients and carers, improved in the follow-up audit. There was no change in patient satisfaction levels; however, the discrepancy between pain measured by nurses and pain measured by patients was reduced. The JBI methodology was useful in improving compliance with evidence-based practice criteria. It also facilitated adaptation to new barriers, such as the COVID-19 pandemic. Improving nurses' knowledge of pain assessment can lead to more accurate assessment. Inadequate records systems also made it difficult to record the care that was provided. Subsequent audits will assess sustainability and the project will be escalated to other wards.

Antenatal and intrapartum care for women with gestational diabetes: a best practice implementation project.

This project aimed to improve the quality of antenatal and intrapartum care for women with gestational diabetes (GD) by increasing nursing and midwifery care compliance with best practice recommendations. GD is one of the most common diseases that can lead to several important maternal and fetal complications. This project was based on JBI's evidence implementation approach and included a baseline audit, the implementation of strategies, and a follow-up audit. The project was conducted in an obstetrics-gynecology department of a hospital in Bucharest, and the sample included 30 pregnant women with GD from that ward. Regarding antenatal care, the baseline audit revealed low compliance (63%-87%) for criterion 2 (specific education), criterion 3 (multidisciplinary team), criterion 4 (individualized care plan), criterion 5 (training on self-monitoring), criterion 8 (dietician consultation), and criterion 10 (physical exercise program). Compliance with criterion 9 (physiotherapist consultation) was nil. Higher compliance (90%-100%) was reported for criterion 1 (screening for GD), criterion 6 (self-monitoring), and criterion 7 (maintenance of glycemic values). The intrapartum care audit criteria regarding maintaining blood glucose levels had compliance rates of 97% (criteria 13 and 14), 73% (criterion 11), and 67% (criterion 12). As a result of implementing the most appropriate strategies, maximum improvement was observed for all 12 audit criteria found to be deficient in the baseline audit. Strategies were identified and applied to successfully implement the best practices (educational programs and improved procedures). However, specific actions, such as regular targeted audits and continuous monitoring, are needed to maintain long-term results.

Postdischarge telephone follow-up among chronic disease patients discharged from a vascular surgery service: a best practice implementation project.

To improve postdischarge telephone follow-up in the context of chronic disease management (peripheral artery disease), in a vascular surgery service. Patients with chronic diseases, such as peripheral artery disease, present a higher risk of complications and greater constraints regarding their adherence to treatment, leading to an increasing mortality rate and decreased functional capacity. Comprehensive discharge planning plus postdischarge telephone follow-up may reduce 30-day re-hospitalization rates. The project used the JBI audit and feedback methodological approach to implement the best available evidence into practice. Two audit criteria were used: existence of comprehensive discharge planning and timely telephone follow-up. A baseline audit was conducted, followed by analysis of barriers, which led to the implementation of several strategies, namely, a targeted training program, the development of educational resources and standardized procedures for the discharge process, and postdischarge telephone follow-up. Results from the baseline and first follow-up audits showed improvement for both criteria. Compliance for criterion 1 (comprehensive discharge planning, including postdischarge telephone follow-up) increased from 0% to 40.7%, and for criterion 2 (patient is followed up by telephone within 2 weeks of discharge) increased from 0% to 44.4%. These two criteria sustained improvements in the second follow-up audit: compliance increased to 45% (criterion 1) and 60% (criterion 2). This implementation project contributed to the optimization of the chronic disease management, including improved compliance with discharge planning and early postdischarge telephone follow-up.

Patient-centered health care planning in acute inpatient mental health settings: a best practice implementation project.

The current project aimed to improve the quality of health care by promoting evidence-based practice (EBP) regarding mental health care planning (MHCP) for adult inpatients. The implementation of the best evidence in the process of developing and documenting nursing care plans is currently an important legal requirement that contributes to increasing the quality of care. This implementation project was based on the JBI evidence implementation approach and included a baseline audit of seven criteria, implementation of strategies, and a follow-up audit. The project was conducted in an acute psychiatric setting at a university hospital in Bucharest, Romania. The sample included 17 nurses and 30 ward patients. The baseline audit revealed low compliance (33%-37%) for criterion 3 (a comprehensive care plan) and criterion 4 (patient involvement); moderate compliance (55%) for criterion 1 (care plan for all patients); and increased compliance (97%-100%) for criterion 2 (assessment of patient's needs), criterion 5 (education of patients/caregivers), criterion 6 (providing a copy at discharge), and criterion 7 (education of professionals). As a result of implementing the most appropriate strategies, the maximum improvement (100%) was observed across all five audit criteria that were found to be deficient in the baseline audit. The development and implementation of strategies adapted to specific care need to play a key role in the implementation of EBP. In this case, educating nurses, facilitating nurses' access to EBP for care planning, and improving procedures proved effective in achieving maximum compliance with all the audit criteria.

Implementation of virtual music therapy in the practice of Czech music therapists: a best practice implementation project.

Czech music therapists lacked the skills and knowledge to adapt their practice to virtual music therapy (VMT) at the beginning of the COVID-19 pandemic, when physical contact was restricted. The aims of this project were to implement the best evidence-based recommendations concerning VMT in the practice of Czech music therapists and increase the number of therapists using VMT. The project used the JBI Evidence Implementation Framework to promote change in the practice of participants. A baseline audit of 26 practitioners was conducted using questionnaires and interviews. The audit criteria consisted of 8 best practice recommendations, followed by the implementation of targeted strategies and a follow-up audit. Of the 26 music therapists, 18 began practicing VMT following the rollout of the implementation strategies. Strategies included educational workshops, instructional materials, technological support, individual counseling, and interactive training sessions. There was an increase in compliance with all audit criteria. The most critical barriers were lack of knowledge about VMT and lack of technical skills; lack of resources; technological challenges; low confidence of music therapists to provide VMT; and reduced need for VMT after the lockdown restrictions were relaxed. The implementation project helped to overcome temporary pandemic restrictions, increase the quality of VMT practice, develop strategies for VMT training, and identify reasons for using VMT during the pandemic and beyond.

Screening, prevention, and management of patients with poststroke depression in a tertiary hospital in China: a best practice implementation project.

Poststroke depression (PSD) is common but insufficiently addressed by health professionals, and management is not always evidence-based. This evidence implementation project aimed to improve adherence to evidence-based practice for screening, prevention, and management of patients with PSD in the neurology ward of the Fifth Affiliated Hospital of Zunyi Medical University, China. This project was based on the JBI methodological approach and was conducted in three phases, from January to June 2021: a baseline audit, implementation of strategies, and a follow-up audit. We utilized the JBI Practical Application of Clinical Evidence System software and the Getting Research into Practice tools. Fourteen nurses, 162 stroke patients, and their caregivers participated in this study. The results of the baseline audit showed that compliance with evidence-based practice was poor, with 3/6 criteria showing 0% adherence and the other three audit criteria showing 5.7, 10.3, and 49.4% adherence, respectively. Through feedback to nurses regarding the baseline audit results, the project team identified five barriers and adopted a battery of strategies to overcome these barriers. The follow-up audit revealed significantly enhanced outcomes across all the best practice criteria, and the compliance of each criterion reached at least 80%. The implementation program designed to screen, prevent, and manage PSD in a tertiary hospital in China improved nurses' knowledge and compliance with evidence-based management of PSD. Further testing of this program in more hospitals is needed.

Effectiveness of implementation strategies to improve nutrition education interventions in adults living in rural and/or low-income communities.

The objective of this project was to promote evidence-based practice and identify how to best implement nutrition education interventions for adults living in rural and/or low-income communities. Adults living in rural and/or low-income communities are at increased risk for poor nutrition and chronic health conditions. Patients are referred to the EversCare Clinic (ECC), an ambulatory clinic at an academic medical center in Mississippi, USA, to receive assistance with social needs. In addition to living in rural and/or low-income communities, over 90% of the patients seen at the ECC are food-insecure, yet nutrition education is inconsistently provided. The JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit and feedback tools were used. The ECC team conducted a baseline audit of 30 patient electronic health records, designed and implemented best-practice nutrition education strategies, and completed a follow-up audit of 30 patient electronic health records. Four evidence-based criteria for nutrition education in adults living in rural and/or low-income communities were audited, and various interventions were used to address multiple levels. The baseline audit revealed patients were not receiving recommended nutrition education interventions. Following the implementation, there was a 64.2% improvement in compliance with all four best practice criteria. Involving nursing students proved to be an effective method of improving compliance. Adherence to best practices regarding implementing nutrition education interventions was satisfactory, with 80% of patients receiving interventions at individual, interpersonal, community, and societal levels. Future audits are planned to ensure sustainability.

IMPLEMENTATION OF INTERNAL AUDIT FOLLOW-UP OF THE INDONESIAN GOVERNMENT INTERNAL AUDIT STANDARDS VERSION AT INSPECTORATE I OF CHIEF INSPECTORATE OF THE SECRETARIAT GENERAL OF THE HOUSE OF REPRESENTATIVES OF THE REPUBLIC OF INDONESIA

This research aims to determine the implementation of the follow-up internal audit recommendations of the Indonesian Government Internal Audit Standards version at Inspectorate I. Based on Attribution Theory by Fritz Heider (1958), human behavior is deviant and tends to benefit itself due to internal and external factors, so supervision and control are needed to achieve good, clear, and clean governance. This research uses a qualitative approach with data collection methods through interviews and documentation studies. This research concludes that Inspectorate I has implemented some of the follow-up internal audit recommendations according to the Indonesian Government's Internal Audit Standards version. The constraints found in mandatory assignments that have not been captured in the Annual Audit Internal Activities Program, absence of monitoring activities, lack of leadership commitment in completing audit internal recommendations, and lack of awareness from clients to complete audit internal recommendations. Therefore, it is necessary to share the mandatory assignments to Inspectorate II through the authority of The Chief Inspectorate, programming audit internal recommendations monitoring 2 (two) times a year, implement audit communication optimally, and cascade the follow-up of auditor internal recommendations to the clients/units Key Performance Indicators.

Reducing Metabolic Bone Disease Burden in Intestinal Failure Children on Home Parenteral Nutrition.

To determine the prevalence of secondary hyperparathyroidism in a cohort of pediatric patients receiving home parenteral nutrition. For a service review, a population-based cohort of 37 pediatric intestinal failure patients receiving long-term parenteral nutrition that underwent serial biochemical monitoring during a study period of approximately 4 years were examined. Following the production of an algorithm, a follow-up audit was carried out (n = 33) after approximately 6 months. Of the 37 patients examined in the initial service review, 22 (59%) were found to have an elevated parathyroid hormone (PTH) during the period of monitoring and 5 (14%) had a persistently elevated PTH. In the follow-up audit following the implementation of an algorithm, the number with elevated PTH reduced to 6 (18%) and no patients had persistently high levels. Elevated PTH is a common biochemical finding in pediatric intestinal failure patients receiving home parenteral nutrition and its presence should alert clinicians to the need to optimize nutritional parameters such as calcium to phosphate molar ratio and vitamin D status; failure to do so may increase the future burden of metabolic bone disease in such patients. We propose that an algorithm may help in this endeavor.

Assessment and management of radiation-induced trismus in patients with nasopharyngeal carcinoma: a best practice implementation project.

Intensity-modulated radiotherapy (IMRT) is the most commonly used radiotherapy technology in oncology, which enables precise conformation of the radiation dose to the target volume and reduces the risk of radiation damage to the adjacent normal structures. Nevertheless, it is still inevitable for IMRT of head and neck cancer to cause radiation-related toxic and side effects, such as dry mouth, mucositis, oral dysarthria, taste disorder, osteonecrosis and trismus. Trismus is one of the most common late side effects caused by radiotherapy of nasopharyngeal carcinoma (NPC), which seriously impact the quality of life for patients with NPC. However, the current clinical assessment and management of trismus after radiotherapy for NPC are still imperfect. This best practice implementation project aimed to implement an evidence-based practice in assessing and managing trismus for NPC patients who underwent radiotherapy, thereby improving the compliance of clinical practice with the best evidence and the quality of life of patients with NPC. This is an evidence-based audit and feedback project implemented using a three-phase approach at a Third-Class hospital in China, following JBI's Practical Application of Clinical Evidence System (PACES) and GRiP evidence application. The first phase included a baseline audit with six evidence-based audit criteria based on the best available evidence. The second phase included analyzing the results of the baseline audit, identifying barriers to compliance with best practice principles, and developing and implementing strategies to address the barriers identified in the baseline audit. The third phase involved a follow-up audit carried out to assess the results of interventions implemented to improve practice. After evidence application, the compliance rate of audit criterion 1 increased from 0% at baseline audit to 70% at follow-up audit. The compliance rate of audit criterion 2 increased from 0 to 100%. The compliance rate of audit criterion 3 increased from 22 to 62%. The compliance rate of audit criterion 4 increased from 88 to 100%. The compliance rate of audit criterion 5 was 100% at baseline audit and follow-up audit. The compliance rate of audit criterion 6 increased from 0 to 55%. Implementation of the best evidence for the assessment and management of trismus of patients with NPC after radiotherapy is conducive to improving the compliance of clinical practice with the best evidence, standardizing clinical nursing practice, improving the quality of clinical nursing, and better preventing severe trismus in patients with NPC after radiotherapy.

Enhancing bladder management for intrapartum/postpartum women at a maternity hospital in Taiwan: a best practice implementation project.

Voiding dysfunction is a common perinatal condition. Appropriate bladder management and monitoring during labor and postpartum improves bladder function and reduces the incidence of infections and complications. This project aimed to promote evidence-based bladder-management strategies for perinatal women at a maternity hospital in Taiwan. The project was implemented using the JBI framework and the Practical Application of Clinical Evidence System. Implementation audits were conducted by examining nurses and intra- and postpartum women. Ten criteria were applied in the baseline audit, and two follow-up audits were conducted to assess actual compliance with best-practice recommendations. Through a Getting Research into Practice analysis, we identified three barriers to and facilitators of changing practice. A comparison of the audit outcomes revealed that all criteria had improved by the second follow-up audit cycle. Specifically, the compliance rate increased from 37% and 50% to 100% for criteria 1 and 2, respectively; from 0% to 100% for criteria 3, 5, and 10; and from 7%, 28%, 50%, and 17% to 100%, 100%, 97%, and 100% for criteria 4, 6, 8, and 9, respectively. Following implementation, the frequency of intrapartum intermittent catheterization (53.44-38.30%) and the postpartum incidence of urinary retention (9.09-8.51%) decreased. The time to first voiding after vaginal delivery and between the first and the second voiding decreased from 5.51 and 4.01 h to 2.32 and 2.29 h, respectively. This evidence-based implementation project achieved substantial improvements in bladder management. Relational leadership theory, which integrates empowerment, purposefulness, ethical behaviors, and process orientation, underpinned the project.

Nursing assessments of women with hypertensive disorders during labor in an academic medical center in Mississippi: a best practice implementation project

The objective of this project was to promote evidence-based practices regarding the nursing assessment of pregnant women with hypertensive disorders admitted to the intrapartum unit. Hypertension during pregnancy has been associated with adverse maternal and fetal outcomes. Ongoing evaluation and nursing care are key in the prevention of complications resulting from hypertensive disorders in pregnancy. The implementation of this best practice project was guided by the JBI Model of Evidence-based Healthcare and used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback strategy to promote evidence-based practices regarding the nursing assessment of pregnant women with hypertensive disorders admitted to an intrapartum unit. Eight audit criteria that were representative of best-practice recommendations for nursing assessment of pregnant women with hypertensive disorders were used. A baseline audit was conducted, followed by the implementation of multiple strategies that were determined by the key stakeholders. The project was finalized with a follow-up audit to determine a change in compliance with best-practice recommendations. Baseline audits revealed an average 45% compliance rate with the eight best practice audit criteria. An on-site simulation event, which included a nursing assessment of normal and abnormal lung sounds along with the hands-on practice of deep tendon reflexes, was provided by project members. Evidence-based assessment guidelines were presented and reviewed with all participants. Input from the nursing staff was gathered regarding current documentation practices and electronic health record accessibility. As a result, an electronic health record change was requested, and improvements in nursing practice were observed for five of the eight audit criteria. Follow-up audits revealed an average compliance rate of 73% for all eight audit criteria, a 28% improvement. Continuing nursing education and ongoing competency refreshers can affect the quality of client care and outcomes by offering occasions to improve or strengthen clinical expertise and proficiency. For this project, the simulation training event improved nursing staff compliance with best practices.

Promoting post discharge telephone follow-up of patients with transurethral resection for bladder cancer: a best practice implementation project.

Telephone follow-up (TFU) is a method that can be recommended for patients with chronic disease, including patients with nonmuscle-invasive bladder cancer (NMIBC) after transurethral resection of the bladder (TURB). This project aimed to improve postdischarge TFU of patients with TURB in a tertiary care system and referral system in Tabriz, Iran. This evidence implementation project used the JBI evidence implementation framework. Two audit criteria were used. A baseline audit was conducted, followed by the implementation of multiple strategies. The project was finalized with a follow-up audit to evaluate changes in practice. The aggregated data collated from the urology ward demonstrated that all criteria had achieved 0% compliance in the baseline audit round. Strategies such as patient education about TFU, educational pamphlets developed according to the latest validated guidelines, and a mobile app for education material about bladder cancer, diagnosis, management, and follow-up were implemented. The Phase 3 follow-up showed an 88% increase in compliance with staff education about the postdischarge TFU as a component of comprehensive discharge planning and a 22% achievement of timely patient follow-up by telephone. A clinical audit is an effective approach to promoting postdischarge TFU in bladder cancer cases following TURB. TFU for bladder cancer patients who underwent TURB is an optimal goal that is easily achieved through patient, nursing staff, and residents' education using the latest guidelines.

1162 Management of Acute Gallstone Disease at an Urban Acute Trust During the Pandemic – Closed-Loop Audit

Abstract Aim Acute gallstone disease is a surgical emergency with emphasis on early surgery (Laparoscopic Cholecystectomy (LC)) to improve outcomes. Method Patients presenting with acute cholecystitis, biliary colic, and gallstone pancreatitis between September and December 2021 were retrospectively audited. We measured re-admission rates, emergency and elective cholecystectomies performed, and interval between operation and initial admission. This revealed a need for improvement in the service provided at this trust. An intervention was implemented with the Hot Cholecystectomy list being available for other surgeons as well as encouraging acute LC on the Emergency theatre list. A follow-up retrospective audit was carried out between July and September 2022 using the same criteria as per the initial data collection. Results 240 patients were admitted with acute gallstone disease during the initial audit period. At the end of audit period, 49 patients underwent LC, of which only 20% were performed acutely. However, 70% of acute operations were performed during re-admissions. During the re-audit, 109 patients were admitted with acute gallstone disease. Within the three months, 21% of patients underwent LC, out of which 52% were acute operations. 50% of the emergency operations were in re-admission patients. Patients from the initial audit were followed up which revealed average waiting time of 118.5 days from admission to LC Conclusions There was almost a 3-fold increase in the rate of Emergency LC post intervention. While there is an increase, provision of emergency cholecystectomies does not comply with national guidelines. Resources need to be allocated nationwide for timely treatment of acute gallstone disease.

The influence of Internal Control effectiveness on Audit pricing: based on the empirical Evidence of Shenzhen Stock Exchange Manufacturing Industry

In recent years, incidents such as chairman Kant being arrested by the police for suspected crimes occur frequently. In the development process of these incidents, the negligence of internal control has played a guiding role. This warns us that listed companies in addition to timely disclosure of internal control reports, establish and improve the internal control system construction, but also the introduction of external supervision system, timely audit work, and the effectiveness of enterprise internal control on the follow-up audit work of audit pricing is worth discussing. This paper takes the data of 354 manufacturing companies listed in 2017 and 2018 in Shenzhen Stock Exchange from 2015 to 2017 in 2018 as samples to explore the impact of the effectiveness of internal control on audit pricing. The empirical results show that there is no significant negative correlation between the effectiveness of internal control of this year and the audit pricing of this year, and a significant negative correlation between the effectiveness of internal control of the previous year and the audit pricing of this year, indicating that the effectiveness of internal control of the previous year is an important influencing factor of the audit pricing of this year. Starting from the effectiveness of internal control, this paper discusses the influencing factors of audit pricing, enriches the research on the influencing factors of audit pricing, and provides relevant reference information for the government to standardize audit pricing.

PENGARUH PENGENDALIAN INTERNAL, TINDAK LANJUT TEMUAN AUDIT TERHADAP PENCEGAHAN FRAUD, KUALITAS LAPORAN KEUANGAN SEBAGAI MEDIASI

This study examines the impact of internal control & follow-up audit findings on fraud prevention, with the quality of financial reports as mediation at the Luwu Raya Inspectorates, using quantitative methods & analyzed using a descriptive approach. The population includes all auditors at the Luwu Raya Inspectorates, the sampling technique uses a saturated sample where all members of the population are sampled, the sample in this study is all auditors at the Luwu Raya Inspectorates with 61 respondents. Data analysis using SEM-PLS (SmartPLS). The research results show that internal control, follow-up on audit findings and the quality of financial reports have a significant influence on fraud prevention. Then, internal control & the follow-up of audit findings have a significant effect on the quality of financial reports, as well as the relationship between follow-up audit findings through the quality of financial reports on fraud prevention where the quality of financial reports is able to mediate the follow-up of audit findings on fraud prevention. Meanwhile, the relationship between internal control through the quality of financial reports on fraud prevention does not have a significant effect.

Follow-Up Audit of Intravenous Amiodarone Administration Practices in an Outer Metropolitan Local Health District

Follow-Up Audit of Intravenous Amiodarone Administration Practices in an Outer Metropolitan Local Health District

Internal control weaknesses: Its relationship with local government characteristics and follow-up on audit results

Internal control plays a critical role in achieving the effectiveness and efficiency of organization's operational activities. This study seeks to investigate the effect of local government size, locally-generated revenue, capital expenditures, social assistance expenditures, and follow-up audit results on local government’s internal control weaknesses. By using multiple linear regressions on 382 samples of local governments in Indonesia, this study found that local government size and social assistance expenditures positively affected internal control weaknesses. Locally-generated revenue negatively affected internal control weaknesses, while capital expenditures and follow-up audit results did not significantly affect internal control weaknesses. This study adds social assistance expenditures, which are still rarely studied by previous researchers because of the large number of irregularities and their discretionary nature. Thus, the results of this study may provide an input for auditors and regulators to focus more on spending on social assistance and further improve comprehensive standards in internal control systems.

Identifying and overcoming racial disparities in triple-negative breast cancer care: Insights from an equity-focused quality improvement initiative.

e18668 Background: Black women incur greater incidence of triple negative breast cancer (TNBC) than White women and when adjusted for age and clinical factors, suffer higher overall mortality, which can be resolved when adjusted for factors relating to care access. This quality improvement (QI) initiative assessed root causes of disparities in care delivery and health equity among TNBC patients in a large health system to identify gaps and develop action plans for improvement. Methods: In March 2021, baseline surveys designed to assess factors that affect quality care of diverse TNBC patients were completed by 10 healthcare providers (HCPs). Baseline chart audits were performed to distinguish contributions to disparities in TNBC treatment and outcomes (N = 100; Black n = 52, Non-Black n = 48). HCPs participated in an audit-feedback (AF) session to (a) assess system-specific practice gaps identified in the provider survey and chart audit, (b) prioritize areas for improvement, and (c) develop action plans for addressing root causes. Post-intervention surveys (N = 11) measured changes in participants’ beliefs and confidence in care delivery. A follow-up chart audit was performed to assess behavioral and practice change (N = 100; Black n = 50, Non-Black n = 50). Results: Baseline surveys revealed the greatest challenge in TNBC patient care was recognizing adverse events (50%) and managing patient non-adherence (30%) . Yet, while 60% of HCPs reported always mentioning the importance of treatment adherence, 0% reported discussing in detail. Chart audits observed substantial disparities in mean days from diagnosis to treatment (67 days Black vs 37 days Non-Black), yet 0% of HCPs named time to treatment a major/main care coordination challenge. Following the AF session, HCPs committed to prioritize improvement within their team individualizing treatment decisions (36% pre-AF vs 73% post-AF). Subsequently, follow-up chart audits revealed increased documented discussions about treatment options (30% vs 59%) and risks and benefits of therapies (58% vs 64%). Mean time from diagnosis to treatment improved for both Black (67 days vs 44 days) and all patients (53 days vs 42 days). Conclusions: Barriers to equitable, patient-centered care in patients with TNBC included insufficient care coordination, delayed time to treatment, and inadequate personalizing of treatment plans by HCPs. Disparities between Black and non-Black patients in the time from diagnosis to treatment were reduced following the QI initiative. Action plans developed by HCPs demonstrate effective strategies to address identified gaps and improve equitable care for patients with TNBC. Study Sponsor Statement: The study reported in this abstract was funded by an educational grant from AstraZeneca, Genentech, and Merck & Co. Inc., who had no role in the study design, execution, analysis, or reporting.