[The quality of care in shoulder pain. A medical audit].
BACKGROUND
To evaluate the quality of hospital ambulatory care in non-surgical painful shoulder by auditing medical records using quality indicators.


METHODS
We reviewed 245 medical records of non-surgical patients assisted for pain shoulder in 1999-2000 in two public hospitals. Quality of care indicators for antecedents, physic exploration, diagnosis and treatment were developed based in systematic reviews of clinical trials, guidelines and expert criteria. Medical records review was carried out by two rehabilitative doctors. Fulfilling of quality criteria and differences between hospitals was analyzed.


RESULTS
76.3% of the medical records did not fulfill > or = 4 of 10 quality criteria for antecedents, 61.6% did not fulfill > or = 3 of 10 criteria for physical exploration, and 7.7% did not have any diagnosis registered. 96.9% of the 98 patients with impingement syndrome did not complete the criteria of anti-inflammatory treatment or infiltration in the pre-established time, and up to 15.3% had not been proposed physiotherapy or programmed exercise in the 4 weeks after the diagnosis; 95.8% of the 24 patients with rotators cuff tears were not proposed for early surgical evaluation, and 86.7% of the 15 cases of adhesive capsulitis did not receive instructions to carry out programmed exercise in the proposed times.


CONCLUSIONS
The audit revealed significant deficiencies in adherence to quality indicators in non-surgical pain shoulder. Part of these problems can be due to low medical records quality.
Marín-Gómez
Manuel
M
Escuela Valenciana de Estudios de la Salud, Conselleria de Sanitat, Valencia, España.
Navarro-Collado
María José
MJ
Peiró
Salvador
S
Trenor-Gomis
Carlos
C
Payá-Rubio
Alfonso
A
Bernal-Delgado
Enrique
E
Hernández-Royo
Antonio
A
D006801:Humans; D008485:Medical Audit; D012189:Retrospective Studies; D020069:Shoulder Pain / Q000175:diagnosis* / Q000628:therapy*