National Clinical Audit of STIs and HIV Feasibility Study
Clinician Consultation Survey
Guidance Notes
Thank you for your interest in the National Clinical Audit of STIs and HIV Feasibility Study
Survey.
The aim of this Survey is to gather feedback from clinicians working in sexual health settings
regarding the proposed audit topics selected by the Project Team, Steering Group and
Reference Group, key considerations for audit methodology and the future implementation
of quality improvement mechanisms.
Before you complete this survey, please:
1. Review the guidance notes about clinical audit and the study aims. This outlines the
purpose of the study, and how a future national clinical audit differs from research
and service evaluation.
2. Review the topic selection process. This details how the shortlisted topics have been
identified and revised through an iterative process.
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Clinical audit and study aims
What is a national clinical audit?
A national clinical audit is a quality improvement process through which current practice is reviewed
against set standards and criteria for care. Areas of good practice and gaps in quality of care delivery
are identified. Action plans are then implemented at the local level to help bridge gaps between
what is currently being achieved and what ‘should’ be achieved, according to national standards. At
a later stage, services are re-audited to identify whether and where improvements have been made.
This whole process is known as an ‘audit cycle’. The emphasis of audit should be on facilitating
quality improvement.
HQIP Clinical Audit Cycle, HQIP
How is audit different from research or service evaluation?
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Research is designed and conducted to derive generalisable new knowledge including
studies that aim to generate hypotheses as well as studies that aim to test them.
Audit is designed and conducted to produce information to inform delivery of best care.
Service evaluation is designed and conducted solely to define or judge current care.
You can use this tool to determine whether a project is audit, research or service evaluation http://www.hra-decisiontools.org.uk/research/
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Is this feasibility study a national clinical audit?
No, this study is not a national clinical audit. This study is a preliminary step that will inform a future
national clinical audit.
The National Clinical Audit of HIV/STI Feasibility Study is a one-year study commissioned by the
Healthcare Quality Improvement Partnership (HQIP). MEDFASH (Medical Foundation for HIV and
Sexual Health) with PHE, BASHH and BHIVA are exploring and evaluating the design of a future
national clinical audit of healthcare for HIV, chlamydia, gonorrhoea, and syphilis in sexual health
services.
The current feasibility study aims will include:
1) Identifying which HIV/STI standards should be audited nationally
2) Assessing whether or not it is feasible to link existing data (PHE, HES and CPRD) to
answer specific audit questions
3) Assessing whether data linkage for audit purposes will be acceptable to patients, the
public and clinicians
4) Designing a future national clinical audit of HIV and STI services
The scope of the feasibility study excludes other STIs not specified above, HIV care delivered in
specialised HIV services (covered by the HIV dashboard) and Patient Reported Outcome Measures
(PROMs)/ Patient Reported Experience Measures (PREMs).
Topic selection process
Combining a literature review and Delphi consultation approach, the Project Team, Steering Group
and Reference Group have identified a shortlist of priority topic areas for exploration in this
feasibility study and potentially for inclusion in a national clinical audit of STI and HIV care.
1. Defined a broad audit question:
'how can clinical services contribute to a reduction in STI transmission?'
2. Developed a longlist of key aspects of STI and HIV care, which are contributing to a reduction in the
onward transmission of STIs and HIV
3. Evaluated all auditable aspects of STI and HIV care against established audit topic selection criteria
4. Identified specific points on the STI and HIV care pathway where poor quality care most adversely
impacts on STI and HIV transmission
5. Developed a shortlist of key aspects of STI and HIV care for inclusion in a national clinical audit
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1. Defined a broad audit question
The Project Team consider that the key concern regarding STIs and HIV infection is that individuals
continue to contract and transmit infections. As a clinical audit focuses on clinical services and care,
the broad question that this feasibility study and future national clinical audit aim to address is:
'How can clinical services contribute to a reduction in STI transmission?'
2. Developed a long list of key aspects of STI and HIV care, which are contributing to a
reduction in the onward transmission of HIV and STIs
During a Steering Group meeting on 20th May 2015, members generated a long list of relevant
topics, with reference to existing standards and guidelines and the previous scoping work of 2013.
The group were asked to highlight aspects of care, including clinical outcomes, which are important
now/ likely to be important in the near future. In addition, the group considered other aspects of
care (‘gaps’) where there is evidence or knowledge of:
(i) variation between settings, location and/or provider
(i) lack of relevant standards or guidelines
(ii) gaps between services and pathways resulting, for example, from changes in the delivery of
care
3. Evaluated all long listed auditable aspects of STI and HIV care against established audit
topic selection criteria
The topic selection criteria that were used to appraise the long listed audit topics related to the risks,
variation, and volume of poor quality care, alignment with national public health priorities, potential
for measurement, amenability to change at the clinical level, likely acceptability among clinicians and
non-clinical stakeholders, patients and the public and complementarity with previous, current and
planned audits and quality improvement initiatives.
4. Identified three specific points on the STI and HIV care pathway where poor quality care
most adversely impacts on STI and HIV transmission
(i) Prior to accessing care
(ii) While awaiting test results and while untreated
(iii) Following test results, prior to or during treatment
5. Developed a shortlist of key aspects of STI and HIV care for inclusion in a national clinical
audit and consulted the study’s Reference Group and PHE data managers regarding
availability of national data
6. Revised audit questions based on feedback from 5.
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