Scaling-up the Systems Analysis and Improvement Approach for prevention of mother-to-child HIV transmission in Mozambique (SAIA-SCALE): a stepped-wedge cluster randomized trial

Sherr, Kenneth; Ásbjörnsdóttir, Kristjana; Crocker, Jonny; Coutinho, J. O.; Cuembelo, Maria de Fátima; Tavede, Esperança; Manaca, Nelia; Ronen, Keshet; Murgorgo, Felipe; Barnabas, Ruanne V.; John‐Stewart, Grace; Holte, Sarah; Weiner, Bryan J.; Pfeiffer, James; Gimbel, Sarah

doi:10.1186/s13012-019-0889-z

Cited by 22 publications

(25 citation statements)

References 34 publications

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“…Given the far-reaching impact of the quality of medical records for surgical and obstetric patient care, our findings highlight the need to address gaps in primary data quality. Previously implemented strategies to strengthen routine data quality include periodic data quality checks by district MOH staff, rapid feedback to resolve data gaps, and implementation of simple report cards/data dashboards to provide aggregate comparisons of key indicators [ 31 ]. Job aids and supervision tools have also been utilized to improve health facility data collection and use [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Assessing completeness of patient medical records of surgical and obstetric patients in Northern Tanzania

Menon

Kuchukhidze

Jumbam

et al. 2020

Global Health Action

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Background: Strengthening surgical services in resource-constrained settings is contingent on using high-quality data to inform decision making at clinical, facility, and policy levels. However, the evidence is sparse on gaps in paper-based medical record quality for surgical and obstetric patients in low-resource settings. Objective: We aim to examine surgical and obstetric patient medical record data quality in health facilities as part of a surgical system strengthening initiative in northern Tanzania. Methods: To measure the incidence of Surgical Site Infections (SSIs), sepsis and maternal sepsis surgical and obstetric inpatients were followed prospectively, over three months in ten primary, district, and regional health facilities in northern Tanzania. Between April 22nd to May 1st, 2018, we retrospectively reviewed paper-based medical records of surgical and obstetric patients diagnosed with SSIs, post-operative sepsis, and maternal sepsis in the three-month follow-up period. A data quality assessment tool with18 data elements related to documentation of SSIs and sepsis diagnosis, their respective symptoms and vital signs, inpatient daily monitoring indicators, and demographic information was developed and used to assess the completeness of patient medical records. Results: Among the 157 patients diagnosed with SSI and sepsis, we found and reviewed 68% of all medical records. Among records reviewed, approximately one third (34%) and one quarter (23%) included documentation of SSI and sepsis diagnoses, respectively. 6% of reviewed records included documentation of all SSI and sepsis diagnoses, symptoms and vital signs, inpatient daily monitoring indicators, and demographic data. Conclusions: Strengthening data quality and record-keeping is essential for surgical team communication, continuity of care, and patient safety, especially in low resource settings where paper-based records are the primary means of data collection. High-quality primary health information provides facilities with actionable data for improving surgical and obstetric care quality at the facility level.

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Section: Discussionmentioning

confidence: 99%

Assessing completeness of patient medical records of surgical and obstetric patients in Northern Tanzania

Menon

Kuchukhidze

Jumbam

et al. 2020

Global Health Action

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“…1). SAIA has been previously described in the literature [40,41]. In brief, in its adapted form, the SAIA-HTN cascade includes the following steps:…”

Section: Methodsmentioning

confidence: 99%

“…Readiness includes (1) change commitment, reflecting shared resolve to implement a change, and (2) change efficacy, reflecting a shared belief in the collective capability to implement change. To understand readiness for adopting SAIA-HTN, we will apply the ORIC assessment scale which has been translated, adapted, and implemented to this context as part of the SAIA-SCALE study prior to launching SAIA-HTN [40]. We will apply the ORIC to eight management team members of each intervention district (n = 48) and eight health workers per intervention facility (n = 64).…”

Section: Organizational Readiness For Implementing Changementioning

confidence: 99%

Systems analysis and improvement approach to optimize the hypertension diagnosis and care cascade for PLHIV individuals (SAIA-HTN): a hybrid type III cluster randomized trial

et al. 2020

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Background: Across sub-Saharan Africa, evidence-based clinical guidelines to screen and manage hypertension exist; however, country level application is low due to lack of service readiness, uneven health worker motivation, weak accountability of health worker performance, and poor integration of hypertension screening and management with chronic care services. The systems analysis and improvement approach (SAIA) is an evidence-based implementation strategy that combines systems engineering tools into a five-step, facility-level package to improve understanding of gaps (cascade analysis), guide identification and prioritization of low-cost workflow modifications (process mapping), and iteratively test and redesign these modifications (continuous quality improvement). As hypertension screening and management are integrated into chronic care services in sub-Saharan Africa, an opportunity exists to test whether SAIA interventions shown to be effective in improving efficiency and coverage of HIV services can be effective when applied to the non-communicable disease services that leverage the same platform. We hypothesize that SAIA-hypertension (SAIA-HTN) will be effective as an adaptable, scalable model for broad implementation. Methods: We will deploy a hybrid type III cluster randomized trial to evaluate the impact of SAIA-HTN on hypertension management in eight intervention and eight control facilities in central Mozambique. Effectiveness outcomes include hypertension cascade flow measures (screening, diagnosis, management, control), as well as hypertension and HIV clinical outcomes among people living with HIV. Cost-effectiveness will be estimated as the incremental costs per additional patient passing through the hypertension cascade steps and the cost per additional disability-adjusted life year averted, from the payer perspective (Ministry of Health). SAIA-HTN implementation fidelity will be measured, and the Consolidated Framework for Implementation Research will guide qualitative evaluation of the implementation process in high-and low-performing facilities to identify determinants of intervention success and failure, and define core and adaptable components of the SAIA-HTN intervention. The Organizational Readiness for Implementing Change scale will measure facility-level readiness for adopting SAIA-HTN.

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“…SAIA has been previously described in the literature. [40,41] In brief, in its adapted form, the SAIA-HTN cascade includes the following steps:…”

Section: Description Of the Saia-htn Implementation Strategymentioning

confidence: 99%

“…To understand readiness for adopting SAIA-HTN, we will apply the ORIC assessment scale which has been translated, adapted, and implemented to this context as part of the SAIA-SCALE study prior to launching SAIA-HTN. [40] We will apply the ORIC to eight management team members of each intervention district (n=48) and eight health workers per intervention facility (n=64). Analysis will test whether sufficient inter-rater reliability and inter-rater agreement exist to aggregate individual responses to the facility level.…”

Section: Organizational Readiness For Implementing Change (Oric)mentioning

confidence: 99%

Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Case Cascade for PLHIV Individuals (SAIA-HTN): A Hybrid Type III Cluster Randomized Trial

Gimbel

Mocumbi

Ásbjörnsdóttir

et al. 2020

Preprint

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BackgroundAcross sub-Saharan Africa, evidence-based clinical guidelines to screen and manage hypertension exist; however, country level application is low due to lack of service readiness, uneven health worker motivation, weak accountability of health worker performance, and poor integration of hypertension screening and management with chronic care services.The Systems Analysis and Improvement Approach (SAIA) is an evidence-based implementation strategy that combines systems engineering tools into a five-step, facility-level package to improve understanding of gaps (cascade analysis), guide identification and prioritization of low-cost workflow modifications (process mapping), and iteratively test and redesign these modifications (continuous quality improvement). As hypertension screening and management are integrated into chronic care services in sub-Saharan Africa, an opportunity exists to test whether SAIA interventions shown to be effective in improving efficiency and coverage of HIV services can be effective when applied to the non-communicable disease services that leverage the same platform. We hypothesize that SAIA-Hypertension (SAIA-HTN) will be effective as an adaptable, scalable model for broad implementation.MethodsWe will deploy a Hybrid Type III cluster randomized trial to evaluate the impact of SAIA-HTN on hypertension management in eight intervention and eight control facilities in central Mozambique. Effectiveness outcomes include hypertension cascade flow measures (screening, diagnosis, management, control), as well as hypertension and HIV clinical outcomes among people living with HIV. Cost-effectiveness will be estimated as the incremental costs per additional patient passing through the hypertension cascade steps and the cost per additional disability-adjusted life year averted, from the payer perspective (Ministry of Health). SAIA-HTN implementation fidelity will be measured, and the Consolidated Framework for Implementation Research will guide qualitative evaluation of the implementation process in high- and low-performing facilities to identify determinants of intervention success and failure, and define core and adaptable components of the SAIA-HTN intervention. The Organizational Readiness for Implementing Change scale will measure facility-level readiness for adopting SAIA-HTN.Discussion:SAIA packages user-friendly systems engineering tools to guide decision-making by front-line health workers to identify low-cost, contextually appropriate chronic care improvement strategies. By integrating SAIA into routine hypertension screening and management structures, this pragmatic trial is designed to test a model for national scale-up.

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Scaling-up the Systems Analysis and Improvement Approach for prevention of mother-to-child HIV transmission in Mozambique (SAIA-SCALE): a stepped-wedge cluster randomized trial

Cited by 22 publications

References 34 publications

Assessing completeness of patient medical records of surgical and obstetric patients in Northern Tanzania

Assessing completeness of patient medical records of surgical and obstetric patients in Northern Tanzania

Systems analysis and improvement approach to optimize the hypertension diagnosis and care cascade for PLHIV individuals (SAIA-HTN): a hybrid type III cluster randomized trial

Systems Analysis and Improvement Approach to Optimize the Hypertension Diagnosis and Case Cascade for PLHIV Individuals (SAIA-HTN): A Hybrid Type III Cluster Randomized Trial

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