Healthcare Quality Assessment Research Articles

Towards a simulation-based framework for decision support in healthcare quality assessment

This article describes a simulation framework for healthcare quality assessment from the perspective of management and corresponding decision-makers. The proposed framework will allow simulating “what-if” scenarios and getting alternative outcomes in case of decision support systems. In our research, we are dealing with heterogeneous data sources, which combine within data-flow processes. The data flow of the presented framework conceptually combines several modeling methods: discrete-event simulation, agent-based modeling and also includes data analysis. The experiments were executed based on data from the Almazov National Medical Research Centre hospital information and access control systems.

Measuring Quality of Healthcare Outcomes in Type 2 Diabetes from Routine Data: a Seven-nation Survey Conducted by the IMIA Primary Health Care Working Group.

Background: The Institute of Medicine framework defines six dimensions of quality for healthcare systems: (1) safety, (2) effectiveness, (3) patient centeredness, (4) timeliness of care, (5) efficiency, and (6) equity. Large health datasets provide an opportunity to assess quality in these areas. Objective: To perform an international comparison of the measurability of the delivery of these aims, in people with type 2 diabetes mellitus (T2DM) from large datasets. Method: We conducted a survey to assess healthcare outcomes data quality of existing databases and disseminated this through professional networks. We examined the data sources used to collect the data, frequency of data uploads, and data types used for identifying people with T2DM. We compared data completeness across the six areas of healthcare quality, using selected measures pertinent to T2DM management. Results: We received 14 responses from seven countries (Australia, Canada, Italy, the Netherlands, Norway, Portugal, Turkey and the UK). Most databases reported frequent data uploads and would be capable of near real time analysis of healthcare quality.The majority of recorded data related to safety (particularly medication adverse events) and treatment efficacy (glycaemic control and microvascular disease). Data potentially measuring equity was less well recorded. Recording levels were lowest for patient-centred care, timeliness of care, and system efficiency, with the majority of databases containing no data in these areas. Databases using primary care sources had higher data quality across all areas measured. Conclusion: Data quality could be improved particularly in the areas of patient-centred care, timeliness, and efficiency. Primary care derived datasets may be most suited to healthcare quality assessment.

Analysis of the Impact of Doctors’ and Health Care System Credibility on Patients’ Satisfaction with Health Care

Forming a patient-oriented health care system, patients’ participation in health care quality assessment has become the imperative of our time.The objective of the research was to analyze the impact of doctors’ and health care system credibility on satisfaction with health care.Materials and methods. Sociological survey of 530 patients was conducted. The patients completed their treatment in the surgical departments of inpatient facilities in Ivano-Frankivsk region. According to its results the patients were divided into two groups: satisfied (372 people) and not satisfied (158 people) with the level of health care services in the department and the hospital as a whole.Results of the research. Nearly 60% of the surveyed patients were determined not to trust their doctors and one third of respondents did not know their primary care physician. This significantly increased the chances of dissatisfaction with health care (OR= 4.11; 95% CI: 1.67–10.14, p<0.001 and OR=1.96; 95% CI: 1.33–2.90 respectively; p<0.001) and promoted inefficient use of the health care system resources as a result of unreasonable hospitalization (in 18.8% cases). Conclusions. Patients who do not trust doctors in general and do not know their general practitioner remain dissatisfied with inpatient care by 1.5-10 times more often.

Design and implementation of community engagement interventions towards healthcare quality improvement in Ghana: a methodological approach.

BackgroundNearly four decades after the Alma-Ata declaration of 1978 on the need for active client/community participation in healthcare, not much has been achieved in this regard particularly in resource constrained countries like Ghana, where over 70 % of communities in rural areas access basic healthcare from primary health facilities. Systematic Community Engagement (SCE) in healthcare quality assessment remains a grey area in many health systems in Africa, albeit the increasing importance in promoting universal access to quality basic healthcare services.Purpose/objectiveDesign and implement SCE interventions that involve existing community groups engaged in healthcare quality assessment in 32 intervention primary health facilities.MethodsThe SCE interventions form part of a four year randomized controlled trial (RCT) in the Greater Accra and Western regions of Ghana. Community groups (n = 52) were purposively recruited and engaged to assess non-technical components of healthcare quality, recommend quality improvement plans and reward best performing facilities. The interventions comprised of five cyclical implementation steps executed for nearly a year. Wilcoxon sign rank test was used to ascertain differences in group perceptions of service quality during the first and second assessments, and ordered logistic regression analysis performed to determine factors associated with groups’ perception of healthcare quality.ResultsHealthcare quality was perceived to be lowest in non-technical areas such as: information provision to clients, directional signs in clinics, drug availability, fairness in queuing, waiting times, and information provision on use of suggestion boxes and feedback on clients’ complaints. Overall, services in private health facilities were perceived to be better than public facilities (p < 0.05). Community groups dominated by artisans and elderly members (60+ years) had better perspectives on healthcare quality than youthful groups (Coef. =1.78; 95 % CI = [−0.16 3.72]) and other categories of community groups (Coef. = 0.98; 95 % CI = [−0.10 2.06]).ConclusionsNon-technical components of healthcare quality remain critical to clients and communities served by primary healthcare providers. The SCE concept is a potential innovative and complementary quality improvement strategy that could help enhance client experiences, trust and confidence in healthcare providers. SCE interventions are more cost effective, community-focused and could easily be scaled-up and sustained by local health authorities.

Assessing quality in emergency health care

We as a family were recently the receivers of health care, with the birth of our firstborn son who arrived a little early. It is always a learning experience to be the receiver of health care, and it certainly focuses the mind as to what is important in its delivery. We were fortunate and I am pleased to say that despite the urgent nature of the situation, both mother and baby are well. However for me — usually the consultant in charge — being admitted for emergency surgery was an eye-opening experience. I have nothing but admiration for Miss Wallace who expertly performed the caesarean section and safely brought both mother and baby through the whole experience. The entire undertaking set me thinking about quality assessment in health care and, in particular, the emergency setting. The PROMs revolution has happened and is the next step in the evidence-based medicine movement focussing outcomes …

Abstract: Plastic Surgery Tool-Kit to Build a Culture of Patient Safety, Quality, and Service

BACKGROUND: Despite the increasing importance of quality assessment and improvement initiatives in health care, national quality measures and patient safety practice guidelines remain difficult to define in plastic surgery. As a quality of life specialty, plastic surgery may require heavier reliance upon unique patient-reported outcomes and different clinical indicators of quality. Comprehensive departmental frameworks for patient safety, quality, and service have yet to be described in the plastic surgery literature. These conditions present us with opportunities to standardize and improve the quality of care. We describe a dynamic model for quality improvement used successfully for the past three years in the Department of Plastic Surgery at Johns Hopkins and provide a tool-kit for implementation across various practice environments and hospital infrastructures. METHODS: Drawing from three years of experience using a Comprehensive Unit-Based Safety Program, formal quality improvement committee structure, literature review, and work from The Johns Hopkins Armstrong Institute for Patient Safety and Quality, we devised a framework specific to and exportable for the field of plastic surgery. RESULTS: Our departmental structure provides channels to facilitate the input and output of naturally trending and recorded data. Monthly Patient Safety, Quality, and Service Committee meetings are a transparent way to address important topics and expeditiously make appropriate changes. Meetings are attended by departmental administration, physicians, physician extenders, clinical support staff, clerical support staff, and trainees, and are structured in a bottom-up fashion to encourage participation from all levels. Four key domains are addressed: (1) safety, (2) external measures, (3) patient experience, and (4) value.1 Examples of indicators we use from these domains include hand washing, pain management, rate of postoperative hematoma, readmission rates, the Breast-Q Reconstruction Survey, and auto-scheduling (pre-scheduling) of postoperative clinic appointments. The core team identifies opportunities and needs; develops, implements, and tracks improvement plans; and celebrates and advertises accomplishments to colleagues, the institution, and the public. CONCLUSION: We anticipate that formal departmental quality improvement structure will promote excellence and national leadership on externally reported measures of patient safety, quality, and service. We provide other plastic surgery departments and divisions with a potential framework that can be adapted to different settings. This work becomes increasingly relevant as value-based reimbursement and pay-for-performance initiatives are implemented with the expectation to drive improvements in healthcare. FINANCIAL DISCLOSURE/CONFLICT OF INTEREST:None of the authors has a financial interest or conflict of interest related to this work. REFERENCES: 1. Kravet SJ, Bailey J, Demski R, Pronovost P. Establishing an ambulatory medicine quality and safety oversight structure: Leveraging the fractal model. Acad Med. 2016: epub ahead of print.

Routine quality care assessment of schizophrenic disorders using information systems.

To assess the quality of mental healthcare provided to patients with schizophrenic disorders in the Italian region of Lombardy. Forty-one clinical indicators were applied to Lombardy's healthcare databases containing data on mental health treatments, hospital admissions, somatic health treatments and pharmaceutical prescriptions. All public departments of mental health and private residential facilities in Lombardy. All 28 227 patients with schizophrenic disorders that were under the care of Lombardy mental health services in 2009. N/A. N/A. The care that was delivered to patients and family members was more frequent for first-episode cases than for prevalent ones. Seven out of ten patients made use of continuing care and, after hospitalization, more than half of the discharged patients received a follow-up visit by community mental health centre staff within 2 weeks of their discharge. Psychotherapeutic and psychoeducative treatments, such as employment and independent living support, were not widespread among these discharged patients. Antipsychotic drug dosage was usually within the recommended range. The adherence of first-episode patients to antipsychotic treatment was lower than that of prevalent patients, and the monitoring of metabolic side effects was not always consistent. Inappropriateness of hospital care, in terms of longer admission, readmission, compulsory admission and restraint, was limited. Mortality during the period was significant. Clinical indicators demonstrate the strengths and weaknesses of the mental health system in Lombardy and they can be useful tools in the routine assessment of mental healthcare quality.

Tracking the origins, defi ning and quantifying

This editorial presents a summary of the narrative used in teaching fundamentals of quality management in healthcare to medical students and health professionals with limited or negative prior experience in the fi eld of quality monitoring and improvement – i.e. those who fi nd the topic dry and disconnected from their everyday clinical experience, lacking in human dimension, and confusing due to the multitude of de fi nitions of quality of care and the considerable inconsistency of the terminology used in quality assessment. In order to remedy the problem, the topic is presented through an historical perspective of the concept of quality as seen throughout the ages - beginning in antiquity, through 19 th and early 20 th century quality control initiatives which evolved into the quality management policies and culture now fi rmly present in many of the contemporary domains of human endeavor. It is also envisioned that specifi c tools developed in this study for didactic purposes (a new defi nition of quality of care and a framework for classifying quality indicators) may play a role in encouraging a more effective dialog among all those passionate about the issue of healthcare quality monitoring, assessment, and improvement.

Aspiring to Unintended Consequences of Natural Language Processing: A Review of Recent Developments in Clinical and Consumer-Generated Text Processing.

This paper reviews work over the past two years in Natural Language Processing (NLP) applied to clinical and consumer-generated texts. We included any application or methodological publication that leverages text to facilitate healthcare and address the health-related needs of consumers and populations. Many important developments in clinical text processing, both foundational and task-oriented, were addressed in community- wide evaluations and discussed in corresponding special issues that are referenced in this review. These focused issues and in-depth reviews of several other active research areas, such as pharmacovigilance and summarization, allowed us to discuss in greater depth disease modeling and predictive analytics using clinical texts, and text analysis in social media for healthcare quality assessment, trends towards online interventions based on rapid analysis of health-related posts, and consumer health question answering, among other issues. Our analysis shows that although clinical NLP continues to advance towards practical applications and more NLP methods are used in large-scale live health information applications, more needs to be done to make NLP use in clinical applications a routine widespread reality. Progress in clinical NLP is mirrored by developments in social media text analysis: the research is moving from capturing trends to addressing individual health-related posts, thus showing potential to become a tool for precision medicine and a valuable addition to the standard healthcare quality evaluation tools.

Assessing the Impact of Community Engagement Interventions on Health Worker Motivation and Experiences with Clients in Primary Health Facilities in Ghana: A Randomized Cluster Trial.

BackgroundHealth worker density per 1000 population in Ghana is one of the lowest in the world estimated to be 2.3, below the global average of 9.3. Low health worker motivation induced by poor working conditions partly explain this challenge. Albeit the wage bill for public sector health workers is about 90% of domestic government expenditure on health in countries such as Ghana, staff motivation and performance output remain a challenge, suggesting the need to complement financial incentives with non-financial incentives through a community-based approach. In this study, a systematic community engagement (SCE) intervention was implemented to engage community groups in healthcare quality assessment to promote mutual collaboration between clients and healthcare providers, and enhance health worker motivation levels. SCE involves structured use of existing community groups and associations to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements made and rewards given to best performing facilities for closing quality care gaps.PurposeTo evaluate the effect of SCE interventions on health worker motivation and experiences with clients.MethodsThe study is a cluster randomized trial involving health workers in private (n = 38) and public (n = 26) primary healthcare facilities in two administrative regions in Ghana. Out of 324 clinical and non-clinical staff randomly interviewed at baseline, 234 (72%) were successfully followed at end-line and interviewed on workplace motivation factors and personal experiences with clients. Propensity score matching and difference-in-difference estimations were used to estimate treatment effect of the interventions on staff motivation.ResultsIntrinsic (non-financial) work incentives including cordiality with clients and perceived career prospects appeared to be prime sources of motivation for health staff interviewed in intervention health facilities while financial incentives were ranked lowest. Intervention health facilities that were assessed by female community groups (Coef. = 0.2720, p = 0.0118) and informal groups with organized leadership structures like Artisans (Coef. = 0.2268, p = 0.0368) associated positively with higher intrinsic motivation levels of staff.ConclusionCommunity-based approach to health worker motivation is a potential complementary strategy that needs policy deliberation to explore its prospects. Albeit financial incentives remain critical sources of staff motivation, innovative non-financial approaches like SCE should complement the latter.

Pediatric Health Quality Assessment in Different Regions of Russian Federation

The quality of pediatric healthcare is a cornerstone for good maternal and infant health. To evaluate the quality of healthcare in secondary and tertiary regional pediatric hospitals in the Russian Federation. Healthcare quality assessment was performed in 21 pediatric hospitals (tertiary, n=5; secondary, n=16) of four regions. The WHO recommendations were used. In all regions, similar traits of inpatient pediatric healthcare determining a poor quality were observed. These included low preparedness for emergent care at admission departments; a high rate of unjustified hospitalization due to lack of clear indications for inpatient care; a widespread polypharmacy and unnecessary painful procedures and treatment; inadequate unjustified antimicrobial and parenteral therapy. The revealed identity of problems in different regions of the country allows to consider a common strategy to overcome them, which, obviously, should primarily involve education of medical personnel, restructuring of hospital beds to increase day care beds, increasing the clinical expert work in hospitals.

Monitoring mental healthcare on a system level: Country profiles and status from EU countries

AimsRoutinely collected data can be used to monitor the performance and improve the quality of mental healthcare systems. Data-based and system-level Quality Monitoring Programmes in Mental Health Care (QMP-MHC) are increasingly being implemented in EU countries. They are believed to be indispensable for the sustainable improvement of the quality of mental healthcare. However, there is a paucity of comparative research on national strategies in quality monitoring.This study explores the status of system-level Quality Monitoring Programmes in Mental Health Care (QMP-MHC) in EU countries. It aims to provide a descriptive overview, which is intended to be the first step for comparative research in this field. MethodsCase studies of system-level QMP-MHCs were gathered from eight EU countries. Experts from each country were asked to describe their approach using a template. These experts were all members of a Europe-wide network of researchers and members of public institutions involved in quality assessment and performance monitoring of mental healthcare. ResultsCountry profiles were gathered from England, Denmark, France, Germany, Italy, the Netherlands, Portugal, and Sweden. All these countries have – or are in the process of implementing – system-level QMP-MHCs. Implementation seems to be facilitated when a national performance monitoring programme for general healthcare is already in place, although in the Netherlands, a QMP-MHC was established without being attached to a general monitoring programme. All the monitoring programmes described use various quality and performance indicators; some systems enhance this methodology with the addition of qualitative assessment methods such as peer reviews linked to accreditation processes. ConclusionsResearch is needed to better understand the historical, political and technical backgrounds of the different national cases and to explore the effectiveness of different improvement mechanisms on the actual quality of healthcare. Policy makers and those designing performance measurement programmes are recommended to look across the borders of their own healthcare systems as there are many ways to assess performance and many ways to feedback results to service providers. No evidence is available whether one of these methods is superior to the others in improving the quality of mental healthcare.

Challenges and Opportunities in Using Patient-reported Outcomes in Quality Measurement in Rheumatology.

Use of patient-reported outcome measures (PROs) in rheumatology research is widespread, but use of PRO data to evaluate the quality of rheumatologic care delivered is less well established. This article reviews the use of PROs in assessing health care quality, and highlights challenges and opportunities specific to their use in rheumatology quality measurement. It first explores other countries' experiences collecting and evaluating national PRO data to assess quality of care. It describes the current use of PROs as quality measures in rheumatology, and frames an agenda for future work supporting development of meaningful quality measures based on PROs.

Assessing the Associations of Patient-Reported Perceptions of Patient-Centered Care as Supplemental Measures of Health Care Quality in VA.

Patient-reported experience measures (PREMs) are useful for assessing health care quality and safety and patients' perceptions of health care. We aimed to assess the relationship between PREMS [e.g., measures of patient-centered care (PCC)] and health care quality metrics. We conducted a national survey via mail. Survey data were supplemented with US Department of Veteran Affairs (VA) administrative data. Veteran (n = 5512) VA health care users participated in the study. PCC measures included: patient activation; shared decision-making(SDM); empathy and holistic care; chronic illness care; perceptions of participation, respect for choices, and support; and overall health care experience. Health care quality measures included: preventive care screening receipt; chronic condition management (diabetes, hypertension); and health care utilization (hospitalizations, emergency room (ER) visits). Analyses included: bivariate comparisons of PCC measures by health care quality measures; and multivariate linear regression to identify variables associated with attaining multiple positive health care quality indicators (when controlling for potential confounders). PREMs assessing factors relating to patient-provider communication (e.g., empathic provider care, shared decision-making) are mainly related to clinical indicators representing good chronic condition management, while those relating more broadly to health care in general (e.g., patient activation, chronic illness care) are mainly related to measures of appropriate health care use (e.g., preventive care screening receipt; potentially avoidable hospitalizations; unscheduled care, such as ER visits). When controlling for potential confounders, higher perceptions of the decision-making effectiveness component of SDM (β = 0.004, p = 0.03) and empathy and holistic care (β = 0.01, p = 0.02) showed a weak but positive relationship with attaining a greater number of positive health care quality indicators, while a weak but negative relationship emerged for perceptions of participation, respect for choices, and support (β = -0.003, p = 0.03) and overall VA experiences (β = -0.10, p = 0.04). PREMs that measure PCC offer rich data about health care quality while engaging patients, and considering patient experiences and preferences, in performance assessment. PREMs may be used to supplement existing performance metrics.

Assessment of Health Care Quality in Chronic Neurological Diseases: Stroke, Multiple Sclerosis and Epilepsy

Objective: The aim of this study is to assess the quality of care in chronic neurological diseases, and to analyze the correlation between patients’ dependency and the quality of care. Methods: The study is designed as a descriptive and cross-sectional one. It was conducted among 184 patients who had visited neurology clinics of Ataturk University, Turkey, from March 2014 to July 2014. Data was collected by using a Self-made questionnaire, PACIC (Patient Assessment of Chronic Illness Care) and Barthell Index (BI). For data evaluation, percentage distribution, mean, independent samples t test, variance analysis and Pears on correlation analysis were utilized. Results: Overall mean score of PACIC scale was found to be 3.05 ± 0.57. The lowest mean score was obtained in follow-up/coordination subscale (2.73 ± 0.86) among sub-scales of the scale, the highest mean score was found to be in patient activation subscale (3.20 ± 0.74). The mean score for BI was 66.60 ± 38.22. The mean score of PACIC varied significantly according to age, marital status, education, disease diagnosis, co morbid conditions and hospitalization duration and hospital experience. Conclusion: It was found that the satisfaction of patients in terms of chronic disease is at a moderate level, and the highest score was taken in the patient activation subscale, and the lowest score was taken in the follow-up subscale. Moreover, the quality of health care perceptions of independent patients was better.

Antibiotic Control Policies in South Korea, 2000-2013

Antibiotic stewardship is a key strategy for limiting antibiotic resistance. Over the last decade the South Korean government has implemented a series of healthcare policies directed to this end, consisting of legislative separation of drug prescribing and dispensing, antibiotic utilization reviews, healthcare quality assessment, and public reporting. As a result, the proportion of antibiotic prescriptions for acute upper respiratory tract infections in primary healthcare facilities decreased from 72.9% in 2002 to 42.7% in 2013. However, no significant decrease in antibiotic resistance occurred over the same period in clinically important bacteria such as Streptococcus pneumoniae. These government-driven policies played a pivotal role in improving antibiotic use for outpatients and surgical patients in South Korea. However, to achieve long-lasting successful outcomes, coordinated efforts and communications among the stakeholders, including physicians and medical societies, are needed.

Expert assessment of outpatient health care quality in hypertensive patients in a big city

We present the data based on the Registry of hypertensive patients including the results of the expert assessment of the health care in 1539 hypertensive patients. The clinical indicators were evaluated in accordance with the National guidelines on the prevention, diagnosis and management of arterial hypertension. Objective. To perform an expert assessment of out-patient medical care quality in hypertensive patients based on the automated information and analytical system “Registry of Hypertension”. Design and methods. Medical data of 1539 hypertensive patients examined in 2004–2010 were analyzed. Special software (Web-based Registry of Hypertension) produced by Moscow Cardio logical, Scientific and Clinical Centre and Saratov Research Institute of Cardiology was used. It allows continuous data entry and analysis. Results. There is a positive dynamics by improving the quality control of health care in 1539 patients with risk factors and arterial hypertension. Conclusion. Technology “Registry of Hypertension” can be used in treatment and prevention measures in order to perform an expert assessment and improve the quality of health care in hypertensive patients.

Progress Monitoring Measures: The Interaction of Clinician Initial Motivation with Selection and Maintenance Issues

The use of Progress Monitoring (PM) measures has been shown to improve outcomes in therapy for clients who do not follow the normal trajectory of improvement. In addition to improved outcomes, there are several other documented benefits of PM that may motivate clinicians to use PM. Research has examined the broader field of selecting mental health care quality assessment tools and a review of the literature has pointed to the importance of considering motivation for assessment when selecting a measure. However, how motivation influences the selection or maintained usage of PM measures has not been studied. This study examined initial motivation as well as measure selection and continuing use of PM. Consensual Qualitative Research methodology was applied to characterize how clinicians (n = 25) started, selected, and maintained use of PM measures and how initial motivation related to measure selection and continued use. Regardless of initial motivation, convenience and effectiveness emerged as important when selecting and continuing to use a measure. Results are compared to current frameworks for selecting mental health- care quality indicators. Our results suggest that PM measures need to strike a balance, emphasizing convenience as well as efficacy in order to improve clinical uptake and adherence.

Validation of the Portuguese version of a questionnaire to measure Quality of Care Through the Eyes of Patients with Inflammatory Bowel Disease (QUOTE-IBD).

The patient's perspective on the healthcare that they receive has become increasingly important in the assessment of healthcare quality, especially in chronic diseases such as inflammatory bowel disease (IBD). In this context, the questionnaire QUOTE-IBD (Quality of Care Through the Patient's Eyes with Inflammatory Bowel Disease) was created to assess the healthcare quality from the point of view of a patient with IBD. This questionnaire does not yet have a validated Portuguese version (PT-QUOTE-IBD). We aimed to assess the acceptability, validity, and reliability of PT-QUOTE-IBD. This was an observational longitudinal unicentric study with three sequential phases: (a) translation and cultural adaptation of QUOTE-IBD that explores the Importance, Performance and Quality Impact of several dimensions of healthcare; (b) assessment of validity by correlation of the results of PT-QUOTE-IBD and visual analogue scales (VAS); and (c) assessment of the reliability of PT-QUOTE-IBD through a second administration of the questionnaire, with a minimum interval of 4 weeks. We included 114 patients with IBD (77 Crohn's disease and 37 ulcerative colitis). Fifty-nine percent of the patients completed all the questions of QUOTE-IBD and VAS. We obtained positive and significant Pearson's correlation coefficients between QUOTE-IBD scores and VAS for Performance and Quality Impact of Total Care and dimensions Accessibility and Information. Thirty-four (30%) patients completed the second questionnaire adequately. We obtained positive and significant Pearson's correlation coefficients between the two questionnaires for Performance and Quality Impact of Total Care, Accessibility, Continuity of Care, Courtesy and Information, and for Performance of Cost. PT-QUOTE-IBD is acceptable, valid, and reliable in the assessment of Performance and Quality Impact of Total Care, but not of all dimensions of healthcare.

Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities: Evidence from Ghana.

BackgroundPatient safety and quality care remain major challenges to Ghana’s healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE) in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed.PurposeThis paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities.MethodsA randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities.FindingsClinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05) and staff competencies (Coef. = 7.1, p<0.05). Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period. Community groups that were gender balanced, religious/faith-based, and had structured leadership appeared to be better options for effective SCE in healthcare quality assessment.ConclusionCommunity engagement in healthcare quality assessment is a feasible client-centered quality improvement option that should be discussed for possible scale-up in Ghana and other resource poor countries in Africa.