Up to 10% of physicians participating in the PAR Program are offered a personalized review of their office practice by way of a visit from a colleague. This is called a Practice Visit. Physicians are given this option if they score in the top 10th percentile or the bottom 10th percentile on major survey categories or if they cannot recruit sufficient respondents. The goal of the visit is reliable feedback facilitating appropriate choices for quality improvement in office practice.

The Director of Practice Improvement, a practicing physician working part-time for the program, coordinates the Practice Visit program. Other physicians using standardized audit instruments prepared for the PAR Program conduct visits. The Director of Practice Improvement prepares a report and recommendations for each physician on the basis of the Visitor's findings, the PAR Survey results, and his interview with the physician. The content of the report is a confidential document between the Director and the physician.

Visits for surgeons, medical specialists and anesthetists are conducted by a specialist familiar with the physician's type of practice. The visits do not duplicate competency assessment programs to which the physician may currently subscribe. Rather, the visit focuses on the physician's actual performance in areas such as: clinical record-keeping, communication with patients and colleagues, follow-up care, etc.

These instruments sample information about a practice and about the physician's approach to patients' medical problems.

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Non-Specialists:

1. Pre-Visit Questionnaire
2. Office Inspection Checklist
3. Chart Audit Worksheet
4. Chart Stimulated Recall Worksheet

Surgical Specialists:

1. Surgical Specialist Pre-Visit Questionnaire
2. Surgical Specialist Office Inspection Checklist
3. Surgical Specialist Chart Audit Worksheet
4. Surgical Specialist Chart Stimulated Recall Worksheet

Medical Specialists:

1. Medical Specialist Pre-Visit Questionnaire
2. Medical Specialist Office Inspection Checklist
3. Medical Specialist Chart Audit Worksheet
4. Medical Specialist Chart Stimulated Recall Worksheet

Anesthetists:

1. Chart Audit & Interview Summary Worksheet (adapted from the CPSO)

Emergency Care Physicians:

1. Emergency Care Physician Pre-Visit Questionnaire
2. Emergency Care Physician Office Inspection Checklist
3. Emergency Care Physician Chart Audit Worksheet
4. Emergency Care Physician Chart Stimulated Recall Worksheet

Episodic Care Physicians:

1. Episodic Care Physician Pre-Visit Questionnaire
2. Episodic Care Physician Office Inspection Checklist
3. Episodic Care Physician Chart Audit Worksheet
4. Episodic Care Physician Chart Stimulated Recall Worksheet
5. Locum Physician Pre-Visit Questionnaire
6. Locum Physician Chart Audit Worksheet
7. Locum Physician Chart Stimulated Recall Worksheet

A review of these instruments reveals some benchmarks of good practice that are offered by the PAR Program. PAR Practice Visit tools contain a summary of opinions on the elements of good medical practice (e.g. content of medical records, office policies, etc). They may be used as guidance for physicians seeking to make improvements. These tools do not, however, represent a standard of practice endorsed by the College of Physicians & Surgeons of Alberta.

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