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

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

doi:10.1093/intqhc/mzy136

Abstract

ObjectivePresent methods to measure standardized, replicable and comparable metrics to measure quality of medical care in low- and middle-income countries.DesignWe constructed quality indicators for maternal, neonatal and child care. To minimize reviewer judgment, we transformed criteria from check-lists into data points and decisions into conditional algorithms. Distinct criteria were established for each facility level and type of care. Indicators were linked to discharge diagnoses. We designed electronic abstraction tools using computer-assisted personal interviewing software.SettingWe present results for data collected in the poorest areas of Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and the state of Chiapas in Mexico (January—October 2014).ResultsWe collected data from 12 662 medical records. Indicators show variations of quality of care between and within countries. Routine interventions, such as quality antenatal care (ANC), immediate neonatal care and postpartum contraception, had low levels of compliance. Records that complied with quality ANC ranged from 68.8% [confidence interval (CI):64.5–72.9] in Costa Rica to 5.7% [CI:4.0–8.0] in Guatemala. Less than 25% of obstetric and neonatal complications were managed according to standards in all countries.ConclusionsOur study underscores that, with adequate resources and technical expertise, collecting data for quality indicators at scale in low- and middle-income countries is possible. Our indicators offer a comparable, replicable and standardized framework to identify variations on quality of care. The indicators and methods described are highly transferable and could be used to measure quality of care in other countries.

Highlights

Standardized, replicable and comparable metrics for quality of medical care in low- and middle-income countries are lacking [1, 2]
Of the three categories described by Donabedian [11], a gap remains for the performance of processes of care [2]
Antenatal care before 13 weeks gestation Quality antenatal care Use of partograph according to standards Oxytocin administration after birth Obstetric complications managed according to standards Neonatal complications managed according to standards Immediate neonatal care with quality Immediate postpartum care with quality Postpartum contraception Children who received two deworming doses Diarrhea in children treated with oral rehydration salts and zinc Follow-up for children with pneumonia within 2 days

Summary

Introduction

Standardized, replicable and comparable metrics for quality of medical care in low- and middle-income countries are lacking [1, 2]. Poor quality is often attributed to lack of resources [1, 3, 4]; high variation in processes of care has been observed within countries and between countries [4]. Available data mostly considers aspects of healthcare infrastructure, availability of human resources, equipment and supplies, services provided, coverage and outcomes [5,6,7,8]. Adequate healthcare is as much about process as it is about outcome [12, 13]. Outcome data is not useful to understand what processes need improvement [12]

Methods

Results

Conclusion