Patient volume and quality of primary care in Ethiopia: findings from the routine health information system and the 2014 Service Provision Assessment survey

Abstract

Background Several studies have reported inadequate levels of quality of care in the Ethiopian health system. Facility characteristics associated with better quality remain unclear. Understanding associations between patient volumes and quality of care could help organize service delivery and potentially improve patient outcomes. Methods Using data from the routine health management information system (HMIS) and the 2014 Ethiopian Service Provision Assessment survey + we assessed associations between daily total outpatient volumes and quality of services. Quality of care at the facility level was estimated as the average of five measures of provider knowledge (clinical vignettes on malaria and tuberculosis) and competence (observations of family planning, antenatal care and sick child care consultations). We used linear regression models adjusted for several facility-level confounders and region fixed effects with log-transformed patient volume fitted as a linear spline. We repeated analyses for the association between volume of antenatal care visits and quality. Results Our analysis included 424 facilities including 270 health centers, 45 primary hospitals and 109 general hospitals in Ethiopia. Quality was low across all facilities ranging from only 18 to 56% with a mean score of 38%. Outpatient volume varied from less than one patient per day to 581. We found a small but statistically significant association between volume and quality which appeared non-linear, with an inverted U-shape. Among facilities seeing less than 90.6 outpatients per day, quality increased with greater patient volumes. Among facilities seeing 90.6 or more outpatients per day, quality decreased with greater patient volumes. We found a similar association between volume and quality of antenatal care visits. Conclusions Health care utilization and quality must be improved throughout the health system in Ethiopia. Our results are suggestive of a potential U-shape association between volume and quality of primary care services. Understanding the links between volume of patients and quality of care may provide insights for organizing service delivery in Ethiopia and similar contexts.

Perceived quality of care among households ever enrolled in a community-based health insurance scheme in two districts of northeast Ethiopia: a community-based, cross-sectional study

“…Quality decreased with increasing patient volume in health facilities that treated 90.6 or more patients per day, while quality increased with increasing patient volume in health facilities that treated fewer than 90.6 patients per day in the outpatient departments. 51 Our finding is consistent with a study at public hospitals in China where overcrowding was negatively associated with clients’ perception of quality of care. 31 The apparent correlation between patient volume and PQoC could be explained by factors such as increased demand for healthcare providers and longer wait times.…”

“…A study in Ethiopia identified a non-linear significant association (an inverted U-shape) between patient volume and quality. Quality decreased with increasing patient volume in health facilities that treated 90.6 or more patients per day, while quality increased with increasing patient volume in health facilities that treated fewer than 90.6 patients per day in the outpatient departments 51. Our finding is consistent with a study at public hospitals in China where overcrowding was negatively associated with clients’ perception of quality of care 31.…”

Perceived quality of care among households ever enrolled in a community-based health insurance scheme in two districts of northeast Ethiopia: a multilevel analysis

“…Quality decreased with increasing patient volume in health facilities that treated 90.6 or more patients per day, while quality increased with increasing patient volume in health facilities that treated less than 90.6 patients per day in the outpatient departments. 50 Our finding is consistent with a study at public hospitals in China, 30 where overcrowding was negatively associated with clients’ perception of quality of care. There are two possible explanations for the observed relationship between patient volume and PQoC.…”

Community‐based health insurance service utilization and associated factors in Addis Ababa, Ethiopia

“…This finding assured that the provision of quality service by the public health facilities was poor. The main reason could be the lack of skilled professionals and shortage of equipment due to poverty, although this result is in line with a study conducted in Ethiopia [27].…”