Methods to measure quality of care and quality indicators through health facility surveys in low- and middle-income countries

Ríos-Zertuche, Diego; Zúñiga-Brenes, Paola; Palmisano, Erin B.; Hernández, Bernardo; Schaefer, Alexandra; Johanns, Casey K.; Gonzalez-Marmol, Alvaro; Mokdad, Ali H.; Iriarte, Emma

doi:10.1093/intqhc/mzy136

Cited by 18 publications

(15 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These criteria checklists were then transformed into data points and conditional algorithms for data collection. During field visits, medical record data availability and measurability of criteria were assessed 20. Data collection was conducted by trained physicians and nurses from the region, and data were submitted electronically using the survey software DatStat Illume.…”

Section: Methodsmentioning

confidence: 99%

Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries

et al. 2020

Self Cite

View full text Add to dashboard Cite

ObjectivesHaemorrhage remains the leading cause of maternal mortality in Central America. The Salud Mesoamérica Initiative aims to reduce such mortality via performance indicators. Our objective was to assess the availability and administration of oxytocin, before and after applying Salud Mesoamérica Initiative interventions in the poorest health facilities across Central America.DesignPre-post study.Setting166 basic-level and comprehensive-level health facilities in Belize, Guatemala, Honduras, Mexico, Nicaragua and Panama.ParticipantsA random sample of medical records for uncomplicated full-term deliveries (n=2470) per International Classification of Diseases coding at baseline (July 2011 to August 2013) and at first-phase follow-up (January 2014 to October 2014).InterventionsA year of intervention implementation prior to first-phase follow-up data collection focused on improving access to oxytocin by strengthening supply chains, procurement, storage practices and pharmacy inventory monitoring, using a results-based financing model.Primary and secondary outcome measuresOxytocin availability (primary outcome) and administration (secondary outcome) for postpartum haemorrhage prevention.ResultsAvailability of oxytocin increased from 82.9% to 97.6%. Oxytocin administration increased from 83.6% to 88.4%. Significant improvements were seen for availability of oxytocin (adjusted OR (aOR)=8.41, 95% CI 1.50 to 47.30). Administration of oxytocin was found to be significantly higher in Honduras (aOR=2.96; 95% CI 1.00 to 8.76) in reference to Guatemala at follow-up.ConclusionAfter interventions to increase health facility supplies, the study showed a significant improvement in availability but not administration of oxytocin in poor communities within Mesoamerica. Efforts are needed to improve the use of oxytocin.

show abstract

Section: Methodsmentioning

confidence: 99%

Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Having specified for each indicator a distribution from which the observations were drawn (binomial for indicators 1-3; normal distribution for indicators 4-6), we could formally define outliers as observations more than two standard deviations lower or higher than the common mean (the national average proportion of failure for indicators 1-3, and zero for indicators [4][5][6]. This corresponds to a test of a distributional hypothesis for each facility; the null hypothesis being "H 0 : the facility is drawn from the overall distribution".…”

Section: Statistical Analysis Of Outlying Performancementioning

confidence: 99%

“…Medical records constitute the prime data source to assess adherence to evidence-based clinical guidelines [5]. In high-income countries, electronic medical records (EMRs) are widely used to monitor clinical practices and to study regional variation of medical practices in the US [6].…”

Section: Introductionmentioning

confidence: 99%

Closing the gap in implementation of HIV clinical guidelines in a low resource setting using electronic medical records

Parrish

Desforges

Robin

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

Background: Universal health coverage promises equity in access to and quality of health services. However, there is variability in the quality of the care (QoC) delivered at health facilities in low and middle-income countries (LMICs). Detecting gaps in implementation of clinical guidelines is key to prioritizing the efforts to improve quality of care. The aim of this study was to present statistical methods that maximize the use of existing electronic medical records (EMR) to monitor compliance with evidence-based care guidelines in LMICs. Methods: We used iSanté, Haiti's largest EMR to assess adherence to treatment guidelines and retention on treatment of HIV patients across Haitian HIV care facilities. We selected three processes of care-(1) implementation of a 'test and start' approach to antiretroviral therapy (ART), (2) implementation of HIV viral load testing, and (3) uptake of multi-month scripting for ART, and three continuity of care indicators-(4) timely ART pickup , (5) 6month ART retention of pregnant women and (6) 6-month ART retention of non-pregnant adults. We estimated these six indicators using a model-based approach to account for their volatility and measurement error. We added a case-mix adjustment for continuity of care indicators to account for the effect of factors other than medical care (biological, socioeconomic). We combined the six indicators in a composite measure of appropriate care based on adherence to treatment guidelines. Results: We analyzed data from 65,472 patients seen in 89 health facilities between June 2016 and March 2018. Adoption of treatment guidelines differed greatly between facilities; several facilities displayed 100% compliance failure, suggesting implementation issues. Risk-adjusted continuity of care indicators showed less variability, although several facilities had patient retention rates that deviated significantly from the national average. Based on the composite measure, we identified two facilities with consistently poor performance and two star performers. Conclusions: Our work demonstrates the potential of EMRs to detect gaps in appropriate care processes, and thereby to guide quality improvement efforts. Closing quality gaps will be pivotal in achieving equitable access to quality care in LMICs.

show abstract

“…Discharge abstracts allow institutions to track, for each patient, diagnoses, procedures, complications, and length of stay (CIHI, ), which then allows for calculation of quality indicators. Recently, Central American researchers developed a chart audit tool to assess quality of maternal and infant care across multiple indicators (Rios‐Zertuche, et al, ).…”

Section: Intelligence (Data and Analysis) Generationmentioning

confidence: 99%

Stewardship of quality of care in health systems: Core functions, common pitfalls, and potential solutions

Chan

Veillard

Cowling

et al. 2018

Public Admin & Development

View full text Add to dashboard Cite

National Ministries of Health in low-and middle-income countries (LMICs) have a key role to play as stewards of the quality agenda in their health systems. This paper uses a previously developed six-point framework for stewardship (strategy formulation, intersectoral collaboration, governance and accountability, health system design, policy and regulation, and intelligence generation) and identifies specific examples of activities in LMICs in each of these domains, pitfalls to avoid, and possible solutions to these pitfalls. Many LMICs now have quality strategies with clear vision statements.There are good examples of quality agencies and donor collaboration councils to coordinate activities across different sectors. There are multiple options for accountability, including public reporting, community accountability structures, results-based payment, accreditation, and inspection. To improve health system design, available tools include decision support tools, task-shifting models, supply chain management, and programs to train quality improvement staff. Policy options include legislation on disclosure of adverse events, and regulations to ensure skills of health care providers.Lastly, health information tools include patient registries, facility surveys, hospital discharge abstracts, standardized population and patient surveys, and dedicated agencies for reporting on quality. Policy-makers can use this article to identify options for driving the quality agenda and address anticipated implementation barriers. KEYWORDS accountability, health information management, health policy, less-developed countries, quality improvement, quality of health care, quality strategy, stewardship

show abstract

Methods to measure quality of care and quality indicators through health facility surveys in low- and middle-income countries

Cited by 18 publications

References 23 publications

Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries

Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries

Closing the gap in implementation of HIV clinical guidelines in a low resource setting using electronic medical records

Stewardship of quality of care in health systems: Core functions, common pitfalls, and potential solutions

Contact Info

Product

Resources

About