Audit Of Outcomes Research Articles

Graphical comparison of surgeon outcomes for the audit of a national corneal transplant registry (OTAG study 32).

To compare Kaplan-Meier survival curves and funnel plots for the audit of surgeon-specific corneal transplantation outcomes. We obtained data on all patients with Fuchs endothelial dystrophy (FED) receiving a first corneal transplant in one eye between January 2012 and December 2017. We produced 2-year Kaplan-Meier graft survival curves to compare a simulated individual surgeon's graft survival rate to national pooled data. We used funnel plots to compare all surgeon outcomes to the national graft survival rate with superimposed 95 and 99.8% confidence limits. We defined an outlier as a surgeon who performed ≥10 transplants and had graft survival below the 99.8% national lower limit. To assess the effect of the surgeon case mix, we also compared unadjusted and risk-adjusted graft survival rates. There were 3616 first corneal transplants for FED patients with complete data, performed or overseen by 196 surgeons. The 2-year national graft survival rate was 88%. The median change from the unadjusted to the risk-adjusted graft survival rate for individual surgeons was 0% (IQR: 0%--2%). Of the 108 surgeons who had performed ≥10 transplants, we identified two outliers based on the unadjusted graft survival funnel plot, compared to four outliers based on the risk-adjusted graft survival funnel plot. Funnel plots provide a visually accessible method for comparing individual graft survival rates to the national rate. Risk-adjustment accounts for clinical factors, and this has advantages for audit and clinical governance.

The effect of individual auditor quality on audit outcomes: opening the black box of audit quality

PurposeThis study aims to examine the effect of individual auditor quality (below the partner level) on overall audit quality.Design/methodology/approachWe aggregate audit employee-level individual performance evaluations to create a measure of auditor quality at the office level.FindingsWe find that high-quality audit offices are associated with a lower likelihood of client restatement, fewer client abnormal accruals and a higher likelihood of a client receiving a going concern opinion. We partition employees into low, medium and high level, based on job title, to investigate which employee levels drive these results. We find that the restatement results are driven by high quality high-level employees (Senior Managers/Directors), whereas the going concern results are driven by high quality low-level employees (Seniors). Furthermore, we find evidence that high-quality audit teams are associated with all aspects of audit quality and the magnitude of these team effects are much larger than those of the effects for any individual employee type.Originality/valueOur findings are consistent with higher-level auditors preventing the most serious financial statement deficiencies, low-level employees contributing to audit firm independence and overall team quality creating synergy which has the strongest effect on all aspects of audit quality. These insights based on individual auditor evaluations are new to the literature. Overall, our empirical results suggest that individual auditor quality is associated with higher quality audits and that employees at all levels affect audit outcomes.

Advanced clinical prioritisation in an Irish, tertiary, chronic pain management service: an audit of outcomes.

BackgroundAdvanced clinical prioritisation (ACP) pathways could potentially improve the interface between primary and secondary care, instigating appropriate treatment pathways with improved efficiencies. Telemedicine is a key component of ACP pathways.AimsTelephone consultations for new referrals (as part of a pilot ACP pathway for chronic pain) were trialled to try (a) improve efficiency of outpatient clinics, (b) expedite assessment/treatment, and (c) reduce the number of face-to-face attendances. An audit of this activity was undertaken.MethodsThe 100 longest waiting new referrals were identified. Over a 9-month period patients were contacted via telephone, undergoing an initial assessment. Treatment plans were initiated and outcomes (≥ 1) were documented.ResultsAverage length of time on waiting list was 35.37 months. 40% patients were discharged with advice back to referrer, 8% were referred for diagnostics/imaging, 32% were offered pharmacological management, 30% were scheduled for interventional management, 9% were referred for further MDT assessment/treatment, 4% were referred directly for a pain management programme (PMP), 6% were referred for assessment by other specialist services, 9% were brought in for face-to-face consultation in our pain management OPD, 2% were uncontactable, and 1% had died before assessment could be made.ConclusionsTelemedicine as part of ACP represents an opportunity to improve speed of access to care, reducing the number of patients and time spent on waiting lists. Future studies should be directed at assessing efficacy of treatment plans initiated in telemedicine clinics whilst also looking at cost effectiveness and patient satisfaction.

An audit of genetic referral outcomes at the time of diagnosis of breast cancer

Introduction: Mutations in BRCA1 and BRCA2 account for 5-10% of all female breast cancers, and 15-20% of familial breast cancers. Identifying these mutations at diagnosis can aid shared decision-making in the surgical and oncological setting. NICE guidance recommends referral of high-risk patients to a specialist genetic clinic. This study aims to assess results of genetic testing at diagnosis and time taken for receiving results.

An audit of pharmaceutical continuous manufacturing regulatory submissions and outcomes in the US

Continuous manufacturing (CM) sends materials directly and continuously to the next step of a process, eliminating hold times and reducing processing times. The potential benefits of CM include improved product quality, reduced waste, lower costs, and increased manufacturing flexibility and agility. Some pharmaceutical manufacturers have been hesitant to adopt CM owing to perceived regulatory risks such as increased time to regulatory approval and market entry, more difficulty submitting postapproval changes, and higher inspectional scrutiny. An FDA self-audit of regulatory submissions in the U.S. examined the outcomes, at approval and during the product lifecycle, of continuous manufacturing applications as compared to traditional batch applications. There were no substantial regulatory barriers identified for CM applications related to manufacturing process changes or pre-approval inspections. CM applicants had relatively shorter times to approval and market as compared to similar batch applications, based on the mean or median times to approval (8 or 3 months faster) and marketing (12 or 4 months faster) from submission, translating to an estimated $171–537 M in early revenue benefit.

Obstetric audit of cesarean sections according to M. Robson classification criteria – the experience of St. Petersburg in 2020-2021

An external audit of the childbirth outcomes was conducted in accordance with M. Robsons 10-group classification. The main determinants of indications and the frequency of cesarean section in obstetric medical organizations of St. Petersburg in 2020-2021 were analyzed in order to find effective mechanisms for reducing the frequency of сesarean delivery within the framework of compliance with modern principles of perinatal-oriented obstetrics and the preservation of a womans reproductive health. Possible effective reserves for reducing the frequency of CS are presented: personalized pre-gravidar preparation in high-perinatal risk women groups, personalized approach to methods of pre-induction and induction of labor in high-risk groups patients, rational management of labor in compliance with modern clinical recommendations, wider use of current classical external manual methods for antenatal correction of fetus pelvic presentation, prevention the primary cesarean deliveries, increase in the rate of vaginal deliveries among women with previous cesarean deliveries, optimization of effective antenatal psychological consultation about the delivery methods among pregnant women with breech presentation, previous cesarean deliveries and multiple pregnancy.

An integrated primary care-based programme of PRE-Pregnancy cARE to improve pregnancy outcomes in women with type 2 Diabetes (The\xa0PREPARED\xa0study): protocol for a multi-method study of implementation, system adaptation and performance

BackgroundThe number of women of childbearing age with Type 2 diabetes(T2DM) is increasing, and they now account for > 50% of pregnancies in women with pre-existing diabetes. Diabetes pregnancies without adequate pre-pregnancy care have higher risk for poor outcomes (miscarriages, birth-defects, stillbirths) and are associated with increased complications (caesarean deliveries, macrosomic babies, neonatal intensive-care admissions). The risks and costs of these pregnancies can be reduced with pregnancy preparation (HbA1c, ≤ 6.5%, 5 mg folic acid and stopping potentially harmful medicines). However, 90% of women with T2DM, most of whom are based in primary care, are not adequately prepared for pregnancy. This study will evaluate a programme of primary care-based interventions (decision-support systems; pre-pregnancy care-pathways; pregnancy-awareness resources; professional training; and performance monitoring) to improve pregnancy preparation in women with T2DM.MethodsThe study aims to optimise the programme interventions and estimate their impact on pregnancy preparation, pre-pregnancy care uptake and pregnancy outcomes. To evaluate this multimodal intervention, we will use a multi-method research design following Complex Adaptive Systems (CAS) theory, refining the interventions iteratively during the study. Thirty GP practices with ≥ 25 women with T2DM of reproductive age (18–45 years) from two South London boroughs will be exposed to the intervention. This will provide > 750 women with an estimated pregnancy incidence of 80–100 to study. The research involves: a clinical audit of processes and outcomes; a process evaluation informing intervention feasibility, implementation, and behaviour change; and a cost-consequences analysis informing future economic evaluation. Performance data will be collected via audits of GP systems, hospital antenatal clinics and pregnancy outcomes. Following CAS theory, we will use repeated measurements to monitor intervention impact on pregnancy preparation markers at 4-monthly intervals over 18-months. We will use performance and feasibility data to optimise intervention effects iteratively. The target performance for the intervention is a 30% increase in the proportion of women meeting pre-pregnancy care criteria.DiscussionThe primary output will be development of an integrated programme of interventions to improve pregnancy preparation, pre-pregnancy care uptake, and reduce adverse pregnancy outcomes in women with T2DM. We will also develop an implementation plan to support the introduction of the interventions across the NHS.Trial registrationISRCTN47576591; February 8, 2022.

Segmenting households based on food waste behaviours and waste audit outcomes: Introducing Over Providers, Under Planners and Considerate Planners

Households are responsible for a significant amount of food waste, estimated to be around 50% of economic value in developed countries. This food waste emerges from the complex interplay of behaviours associated with the planning, shopping, storing, preparing and disposing practices of food provisioning. Three segments were identified based on analysis of behaviours measured in a national survey in Australia (n = 2803). Profiles of these segments were enriched with further insights from in-depth interviews with householders (n = 6). Rather than relying on potentially inaccurate self-reported surveys, actual food waste was measured by auditing waste bins from a selection of survey participants (n = 454). Results show that “Over Providers” (23% of households), with the highest food waste per household based primarily on the challenge of providing food for children, warrant a priority focus for interventions from policymakers and practitioners. “Under Planners” (32%), with their general disinterest in food, are unlikely to respond to information-based interventions and hence changes in behaviour will require a shift in choice architecture in food shopping environments. Whilst “Considerate Planners” (45%), tending to be older, show how experience and freedom to allocate more time to food provisioning support them in having the lowest food waste per household. Incorporating these insights in the design of food waste interventions will likely increase their effectiveness.

Criminal History, Race, and Housing Type: An Experimental Audit of Housing Outcomes

Although there are a number of experimental studies showing that private housing can be difficult to secure for those with criminal history, many issues in this area remain unexplored or underexplored. The goal of the current study was to address the following unexplored or underexplored issues: (a) the impact of various types of multiple conviction records on private housing outcomes, including one that possessed a certificate of relief; (b) racial differences in private housing outcomes; (c) the impact of housing type on private housing outcomes; and (d) the impact of a criminal record, race, and housing type interaction on private housing outcomes. This goal was achieved with the use of a field experiment (correspondence audit). Results showed several statistically and substantively significant differences among the criminal record, race, and housing type conditions. These results can be used to better inform individuals with criminal history who are seeking private housing options.

Audit of long-term treatment outcomes of thyrotoxicosis in a single-centre virtual clinic: The utility of long-term antithyroid drugs.

To investigate the long-term outcomes and prognosis of thyrotoxicosis in a large number of patients in a single UK county (Leicestershire). Retrospective cohort analysis of 56,741 thyroid function test (TFT) results, treatment modalities and outcomes in a well-established virtual thyrotoxicosis clinic database. One thousand four hundred and eighty-ninepatients were included with a median length of follow-up of 10.9 years. The aetiology of thyrotoxicosis was autoimmune (85.9%), nodular (9.1%)and mixed (5.0%). Treatment modalities included antithyroid drugs (ATDs), radioiodine (RAI; 555 MBq fixed dose) and thyroidectomy. We analysed both individual TFTsand groups of sequential TFTs onor afterthe same thyroid treatment(s), which we describe as 'phaseof thyroid care'(POTC). Patients studied entered the virtual clinic between 1 January 1995 and 1 January 2010; we exported data on every TFT sample up to April 2020. ATD had been used in 99.2% (median 2, maximumsevencourses) with long-term ATD (>2years) in 48%. RAI and thyroidectomy were used more commonly with nodular and mixed aetiology. Overall, T4 was more often controlled than thyroid-stimulating hormone (TSH), and at the latest follow-up, T4 was normal in >96%, TSH in >79% and both in >76% of different aetiologies. The mean percentage control of T4 was 85% and TSH 50%; in long-term ATD courses, this improved to 89% and 62%, respectively. In the latest POTC, control of T4 and TSH was best in cases off treatment (95%/87%) and on T4 without ablative therapy (94%/72%), but was broadly similar in patients on long-term ATD (90%/68%), after RAI (92%/60%) or after thyroidectomy (91%/58%). After the first course of ATD, remission or hypothyroidism was seen in 47.3% autoimmune, 20.9% nodular and 32.5% mixed, with 90% relapses seen within 4years. Relapse was more common in patients with ophthalmopathy, but there was no difference between the sexes. Thyrotoxicosis can be well controlled with minimal specialist clinic attendance using a software-supported virtual shared-care scheme. Long-term ATD appears to be a valid patient choice achieving TFT control comparable to that seen after RAI or surgery. In patients with autoimmune disease, relapse is more common in patients with ophthalmopathy, and hypothyroidism is common after RAI. In nodular disease, we found that spontaneous remission may occur.

Risk adjustment in audit of outcome after head and neck surgery applied to cumulative sum chart methodology to monitor of free flap failure

Risk adjustment in audit of outcome after head and neck surgery applied to cumulative sum chart methodology to monitor of free flap failure

The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice.

All units managing hypertensive pregnant women should maintain and review uniform departmental management protocols and conduct regular audits of maternal & fetal outcomes. The cause(s) of pre-eclampsia and the optimal clinical management of the hypertensive disorders of pregnancy remain uncertain; therefore, we recommend that every hypertensive pregnant woman be offered an opportunity to participate in research, clinical trials and follow-up studies.

The impact of PCAOB international registration on audit quality and audit fees: Evidence from China

Despite the importance of registration with the PCAOB, there is surprisingly little academic research on the registration process and its impact on audit outcomes (Abernathy et al., 2013). The PCAOB allows registration of audit firms from non-US countries. However, China and a few other countries do not allow the PCAOB to conduct inspections of audit firms. We take advantage of this setting to investigate whether PCAOB-registered audit firms improve audit quality in the absence of inspections and whether they charge an audit fee premium. Our findings indicate that audit quality increases following PCAOB registration and that clients pay higher audit fees for audits by PCAOB-registered firms.

Optimizing Postoperative Adjuvant Therapy in Elderly Patients with Newly Diagnosed Glioblastoma: Single-Institution Audit of Clinical Outcomes from a Tertiary-Care Comprehensive Cancer Center in India

There is lack of consensus regarding optimal adjuvant therapy in elderly glioblastoma (GBM). We have been treating elderly (≥60 years) GBM patients with normofractionated or hypofractionated radiotherapy (RT) plus temozolomide (TMZ) based on Karnofsky performance status (KPS). Herein we report clinical outcomes in this cohort treated at our institute using this approach. Medical records of elderly GBM patients (≥60 years) treated between 2013 and 2017 with either normofractionated RT (59.4-60 Gy/30-33 fractions/6-6.5 weeks) or hypofractionated RT (35 Gy/10 fractions/2 weeks) plus TMZ were reviewed retrospectively. Outcomes of interest included progression-free survival (PFS), overall survival (OS), and ≥grade 3 myelotoxicity. Time-to-event outcomes were analyzed with Kaplan-Meier methods, compared using log-rank test, and reported as point estimates with 95% confidence interval (CI). The normofractionated cohort (n= 126) was characterized by a higher proportion of patients younger than age 65 years, KPS ≥70, methylated O6-methylguanine DNA methyltransferase (MGMT), and receiving adjuvant TMZ including extended adjuvant TMZ (>6 cycles) compared with the hypofractionated cohort (n= 20), confirming selection bias. At a median follow-up of 13 months, 1-year Kaplan-Meier estimates of PFS and OS were 43% (95% CI: 36%-52%) and 56% (95% CI: 48%-64%), yielding median PFS and OS of 11.0 months and 13.1 months, respectively. Higher KPS, methylated MGMT, normofractionated RT, and extended adjuvant TMZ emerged as favorable prognostic factors. TMZ was well tolerated with a low risk of ≥grade 3 myelotoxicity. Our single-institution clinical audit confirms poor survival in elderly GBM with suboptimal performance status but demonstrates acceptably fair outcomes in patients with preserved KPS comparable with the nonelderly cohort.

149 - 90-Day mortality following lung cancer surgery: contemporary outcomes from the English National Clinical Outcomes Audit

149 - 90-Day mortality following lung cancer surgery: contemporary outcomes from the English National Clinical Outcomes Audit

Auditor Expertise in Mergers and Acquisitions

SUMMARYWe contribute to the literature on auditor's task-specific expertise by examining the role of auditor experience in mergers and acquisitions (M&A), a complicated and increasingly prevalent corporate event that can give rise to misreporting. We find that in industries with more complex accounting, clients of M&A expert auditors are less likely to experience M&A-related misstatements. In industries with less complex accounting, M&A experts pass audit fee savings to their clients during acquisition years. Additional analyses suggest that firms are more likely to switch to an M&A expert auditor during an acquisition year, but only in industries with complex accounting. Overall, our results suggest that firms with an acquisitive strategy that engage with M&A expert auditors experience improved M&A-related audit outcomes.JEL Classifications: M41; M42.

Does Distance Matter? An Investigation of Partners Who Audit Distant Clients and the Effects on Audit Quality†

ABSTRACTWe examine how audit partners' geographic proximity to clients affects audit quality. We use hand‐collected data to show that approximately half of audit partners are assigned to clients headquartered more than 100 km away from the partners' home locations. Few of these partners relocate after receiving their assignments and, as a result, more than one‐third of clients are audited by partners who must commute long distances to visit the client in person. We explore this phenomenon by first modeling how distance affects partner‐client matching. We find that partners' geographic proximity to a prospective client is an important matching criterion, but also that trade‐offs are made when other partner characteristics such as industry specialization are more likely to be important. Next, consistent with our prediction, we show that audit quality is lower when partners reside farther from their clients. We corroborate our primary findings by showing that the association between partner distance and audit quality is mitigated when partners have access to direct flights to their clients' headquarters and when clients are geographically dispersed. Our paper should be informative for regulators, practicing auditors, and academics interested in how partner‐client matching affects audit outcomes.

8-year outcomes following Oncoplastic Therapeutic Mammoplasty with Contralateral Symmetrisation for early breast cancer from a single centre

Background: Clinical best practice in Oncoplastic Breast Surgery outlined by the UK Association of Breast Surgery, recommends the ongoing audit of patient surgical outcomes with clinical, cosmetic and patient-recorded outcomes. This study presents the medium-term clinical outcomes from a single, high-volume tertiary breast referral centre from 8 years of prospective audit of oncoplastic therapeutic mammoplasty with contralateral symmetrisation (TMCS).

Audit Quality: An Analysis of Audit Partner Cultural Proximity to Client Executives

We find that cultural proximity between auditors and CFOs is associated with audit quality. We use recent mandated PCAOB disclosures of engagement audit partners to construct cultural proximity between engagement audit partners and client executives. Building on an extensive literature on homophily in social connections, we hypothesize that when an engagement audit partner is culturally close to client executives, the accounting negotiation is more efficient, resulting in higher audit quality. Consistent with this prediction, we find that audited earnings are of higher quality when the engagement audit partner is culturally close to the CFO. We, however, do not find similar evidence when the engagement audit partner is culturally close to the CEO. Our findings are consistent across several alternative measures of audit quality and cultural proximity. These findings suggest that interpersonal factors from the auditor–client relationship are important for audit outcomes. Our study supports the PCAOB’s position that mandatory disclosures of engagement audit partner identity are helpful in understanding audit quality.

Audit of outcomes following attendance at the City West drive-through IOP glaucoma clinic during the COVID-19 pandemic.

BackgroundGlaucoma is the leading cause of irreversible blindness globally. During the COVID-19 pandemic, an enforced reduction in capacity resulted in the deferral of routine outpatient appointments for glaucoma patients.AimThis study analyses patient outcomes following the establishment of a drive-through intra-ocular pressure (IOP) clinic during the COVID-19 pandemic to alleviate increased pressure on the tertiary glaucoma services at Royal Victoria Eye and Ear Hospital (RVEEH) and Mater Misericordiae University Hospital (MMUH) between August 2020 and June 2021.MethodsA 1-lane driveway system was established in a marquee on the grounds of City West hotel. IOPs were measured in patients’ cars using a hand held iCare100 tonometer. Results were reviewed by a consultant ophthalmologist. At hospital follow-up clinic visits, IOP was measured using the Goldmann applanation tonometer (GAT).ResultsThree hundred one patients of a total of 672 who attended the drive-through clinic have subsequently attended a designated hospital follow-up appointment. In this cohort, the mean drive-through iCare IOP of 19.4 mmHg ± 6.0 was significantly higher (< 0.005) than the mean GAT IOP at the pre-drive through clinic visit (16.3 mmHg ± 3.7) and the post drive-through hospital follow-up visit (17.2 mmHg ± 4.1). Two hundred twenty-six (75%) patients did not need any treatment change, 53 (18%) required eye drop medication changes, 10 (3%) underwent a laser procedure, 4(1%) required surgical intervention, and 8 (3%) were discharged. When patient outcomes were analysed according to IOP grade assigned at the drive-through clinic, those with an iCare IOP < 21 were significantly less likely to require a treatment change. The cohort with iCare IOP ≥ 30 were significantly more likely to have a laser or surgical intervention.ConclusionThe implementation of a drive-through IOP clinic was a safe and effective way to monitor glaucoma patients during COVID-19, and identify those at high risk of poor IOP control or requiring a change in treatment.