Quality of care, risk management, and technology in obstetrics to reduce hospital-based maternal mortality in Senegal and Mali (QUARITE): a cluster-randomised trial

The Lancet ◽  
2013 ◽  
Vol 382 (9887) ◽  
pp. 146-157 ◽  
Author(s):  
Alexandre Dumont ◽  
Pierre Fournier ◽  
Michal Abrahamowicz ◽  
Mamadou Traoré ◽  
Slim Haddad ◽  
...  
Keyword(s):  
Risk Management ◽  
Quality Of Care ◽  
Maternal Mortality ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Cluster Randomised

scholarly journals Improving quality of care during childbirth in primary health centres: a stepped-wedge cluster-randomised trial in India

2018 ◽  
Vol 3 (5) ◽  
pp. e000907 ◽  
Author(s):  
Ramesh Agarwal ◽  
Deepak Chawla ◽  
Minakshi Sharma ◽  
Shyama Nagaranjan ◽  
Suresh K Dalpath ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Management Strategy ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Stepped Wedge ◽  
Primary Health ◽  
Cluster Randomised ◽  
Primary Health Centres ◽  
Health Centres

BackgroundLow/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models.MethodsWe conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3  months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for ‘months of intervention’.ResultsThe intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities.ConclusionA multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India.Trial registration numberCTRI/2016/05/006963.

scholarly journals Supportive supervision to improve the quality and outcome of outpatient care among malnourished children: a cluster randomised trial in Arua district, Uganda

2019 ◽  
Vol 4 (4) ◽  
pp. e001339 ◽  
Author(s):  
Marzia Lazzerini ◽  
Humphrey Wanzira ◽  
Peter Lochoro ◽  
Richard Muyinda ◽  
Giulia Segafredo ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Supportive Supervision ◽  
Phase 2 ◽  
Cure Rate ◽  
Number Of Children ◽  
Malnourished Children ◽  
Cluster Randomised

IntroductionSuboptimal quality of paediatric care has been reported in resource-limited settings, but little evidence exists on interventions to improve it in such settings. This study aimed at testing supportive supervision (SS) for improving health status of malnourished children, quality of case management, overall quality of care, and the absolute number of children enrolled in the nutritional services.MethodsThis was a cluster randomised trial conducted in Arua district. Six health centres (HCs) with the highest volume of work were randomised to either SS or no intervention. SS was delivered by to HCs staff (phase 1), and later extended to community health workers (CHWs) (phase 2). The primary outcome was the cure rate, measured at children level. Quality of case management was assessed by six pre-defined indicators. Quality of care was assessed using the national Nutrition Service Delivery Assessment (NSDA) tool. Access to care was estimated with the number of children accessing HC nutritional services.ResultsOverall, 737 children were enrolled. In the intervention arm, the cure rate (83.8% vs 44.9%, risk ratio (RR)=1.91, 95% CI: 1.56–2.34, p=0.001), quality of care as scored by NSDA (RR=1.57, 95% CI: 1.01–2.44, p=0.035) and correctness in complementary treatment (RR=1.52, 95% CI: 1.40–1.67, p=0.001) were significantly higher compared with control. With the extension of SS to CHWs (phase 2), there was a significant 38.6% more children accessing care in the intervention HCs (RR=1.26, 95% CI: 1.11–1.44, p=0.001) compared with control.ConclusionSS significantly improved the cure rate of malnourished children, and the overall quality of care, SS to CHWs significantly increased the crude number of children enrolled in the nutritional services. More studies should confirm these results, and evaluate the cost-effectiveness of SS.

scholarly journals Reducing unnecessary hospital days to improve quality of care through physician accountability: a cluster randomised trial

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Caterina Caminiti ◽  
Tiziana Meschi ◽  
Luca Braglia ◽  
Francesca Diodati ◽  
Elisa Iezzi ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Improve Quality ◽  
Cluster Randomised ◽  
Hospital Days

OP0106 Effect of a Model Consultation on Quality of Care of Osteoarthritis: A Primary Care Cluster Randomised Trial

2015 ◽  
Vol 74 (Suppl 2) ◽  
pp. 108.3-109
Author(s):  
J.J. Edwards ◽  
K.P. Jordan ◽  
M. Porcheret ◽  
E.L. Healey ◽  
C. Jinks ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Cluster Randomised

Do family meetings for hospitalised palliative care patients improve outcomes and reduce health care costs? A cluster randomised trial

2020 ◽  
pp. 026921632096728
Author(s):  
Peter Hudson ◽  
Afaf Girgis ◽  
Kristina Thomas ◽  
Jennifer Philip ◽  
David C Currow ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life Care ◽  
Randomised Trial ◽  
Cost Benefit ◽  
Cluster Randomised Trial ◽  
Family Meetings ◽  
Cluster Randomised ◽  
Health Utilisation ◽  
The Cost

Background: Family meetings facilitate the exploration of issues and goals of care however, there has been minimal research to determine the benefits and cost implications. Aims: To determine: (1) if family caregivers of hospitalised patients referred to palliative care who receive a structured family meeting report lower psychological distress (primary outcome), fewer unmet needs, improved quality of life; feel more prepared for the caregiving role; and receive better quality of end-of-life care; (2) if outcomes vary dependant upon site of care and; (3) the cost-benefit of implementing meetings into routine practice. Design: Pragmatic cluster randomised trial involving palliative care patients and their primary family caregivers at three Australian hospitals. Participants completed measures upon admission (Time 1); 10 days later (Time 2) and two months after the patient died (Time 3). Regression analyses, health utilisation and process evaluation were conducted. Results: 297 dyads recruited; control ( n = 153) and intervention ( n = 144). The intervention group demonstrated significantly lower psychological distress (Diff: –1.68, p < 0.01) and higher preparedness (Diff: 3.48, p = 0.001) at Time 2. No differences were identified based on quality of end of life care or health utilisation measures. Conclusions: Family meetings may be helpful in reducing family caregiver distress and enhancing their preparedness for the caregiving role and it appears they may be conducted without increased hospital health utilisation impacts; although opportunity costs need to be considered in order to routinely offer these as a standardised intervention. Additional health economic examination is also advocated to comprehensively understand the cost-benefit implications. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12615000200583

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