scholarly journals Development of summary indices of antenatal care service quality in Haiti, Malawi and Tanzania

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032558
Author(s):  
Ashley Sheffel ◽  
Scott Zeger ◽  
Rebecca Heidkamp ◽  
Melinda Kay Munos
Keyword(s):  
Quality Of Care ◽  
Service Quality ◽  
Antenatal Care ◽  
Low Income ◽  
Care Service ◽  
Weighted Average ◽  
The Other ◽  
Provision Of Care ◽  
Facility Readiness

IntroductionMeasuring quality of care in low-income and middle-income countries is complicated by the lack of a standard, universally accepted definition for ‘quality’ for any particular service, as well as limited guidance on which indicators to include in measures of quality of care, and how to incorporate those indicators into summary indices. The aim of this paper is to develop, characterise and compare a set of antenatal care (ANC) indices for facility readiness and provision of care.MethodsWe created nine indices for facility readiness using three methods for selecting items and three methods for combining items. In addition, we created three indices for provision of care using one method for selecting items and three methods for combining items. For each index, we calculated descriptive statistics, categorised the continuous index scores using tercile cut points to assess comparability of facility classification, and examined the variability and distribution of scores.ResultsOur results showed that, within a country, the indices were quite similar in terms of mean index score, facility classification, coefficient of variation, floor and ceiling effects, and the inclusion of items in an index with a range of variability. Notably, the indices created using principal components analysis to combine the items were the most different from the other indices. In addition, the index created by taking a weighted average of a core set of items had lower agreement with the other indices when looking at facility classification.ConclusionsAs improving quality of care becomes integral to global efforts to produce better health outcomes, demand for guidance on creating standardised measures of service quality will grow. This study provides health systems researchers with a comparison of methodologies commonly used to create summary indices of ANC service quality and it highlights the similarities and differences between methods.

scholarly journals STAFFING AND CARE QUALITY OF NURSING HOMES IN KOREA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S702-S702
Author(s):  
Hee Seung Lee
Keyword(s):  
Quality Of Care ◽  
Nursing Homes ◽  
Service Quality ◽  
Social Workers ◽  
Care Service ◽  
Care Quality ◽  
Logit Analysis ◽  
Care Services ◽  
Indirect Care

Abstract Staffing has been regarded as the most important factor for the quality of care service in nursing homes. Korea introduced Long-Term Care Insurance (LTCI) in 2008. The payment system of LTCI has incentivized LTC facilities based on the staffing level of LTC facilities. This study aims to investigate whether staffing is associated with quality of care. The effect of staffing on care quality was assessed using ordered logit analysis. Staffing data in 2015 were retrieved from claim data in the National Health Insurance Service. The publicly reported care service quality grade in 2015 was used as a proxy for care quality. Staffing of registered nurses (RN) and social workers were strongly associated with the care quality. As the number of RNs per residents additionally increased, the LTC facilities were more likely to receive better grades (OR=16851.54, p<0.000). The effect of social workers’ staffing was significant for the care service quality, even though the effect size of smaller than that of RNs (OR=345.87, p<0.000). However, staffing in other professions such as nurse assistants (NA) and personal care workers (PCW) was insignificantly associated with care quality. The effect of staffing on service quality might not be profession-neutral. RN staffing affects most in care quality in Korea. Still, the possibility remains that PCWs or NAs could serve for indirect care services such as cooking or cleaning because of short staffing in indirect care services. This finding could be considered when designing financial incentives for nursing homes in Korea as well as other countries.

scholarly journals Effective Coverage for Nutrition: Operationalizing Effective Coverage Cascades for Nutrition Interventions Delivered to Pregnant Women and Children

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 853-853
Author(s):  
Shannon King ◽  
Rebecca Heidkamp ◽  
Ashley Sheffel ◽  
Yvonne Yiru Xu ◽  
Melinda Munos
Keyword(s):  
Antenatal Care ◽  
Health System ◽  
Sick Child ◽  
Household Survey ◽  
Data Availability ◽  
Nutrition Interventions ◽  
Effective Coverage ◽  
Provision Of Care ◽  
Facility Readiness

Abstract Objectives Many low and middle income country (LMIC) decision makers rely on data from multi-topic household surveys to identify the proportion of the population that has been reached with nutrition services, but these surveys do not always account for the quality of the services. Effective coverage cascades, commonly used in health systems research, capture measures of both coverage and quality to generate actionable information to improve nutrition programs, interventions, and policies. This study aims to describe the operationalization of effective coverage cascades for maternal and child nutrition interventions delivered through the health system using extant data in LMICs. Methods By linking household survey and health facility assessment data from seven LMICs, effective coverage cascades were developed for nutrition interventions delivered through antenatal care visits and sick-child visits. Facility readiness and provision of care index scores were defined for each intervention from clinical guidelines and an expert survey, then refined based on data availability. The facility readiness and provision of care scores were linked to individual care-seeking episodes from household survey data based on geographic domain and facility type. Finally, steps of the coverage cascade for each service in each country were estimated. Results National estimates of the effective coverage cascade for each set of nutrition interventions will be presented. Analysis is ongoing, however preliminary findings show gaps in service readiness such as lack of provider training and gaps in provision of care such as limited nutrition counseling. A substantial drop is seen from service contact to input-adjusted coverage to quality-adjusted coverage for both antenatal care and sick child care. Conclusions The cascade approach yielded summary measures that were useful for identifying high-level barriers to effective coverage; however, detailed measures within the cascade may be more useful for evidence-based decision making. Data availability on quality of care for nutrition interventions is scant, highlighting an opportunity to expand facility-based surveys to include nutrition interventions delivered through the health system. Funding Sources Bill & Melinda Gates Foundation through the DataDENT initiative and the Improving Measurement and Program Design grant.

scholarly journals Translation and validation of a patient satisfaction survey: The isiXhosa version

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Tania Steyl ◽  
Julie Phillips
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Service Quality ◽  
Care Service ◽  
Health Care Service ◽  
Health Centre ◽  
Main Function ◽  
Validity And Reliability

Background: Although the use of surveys has been supported for assessing understanding of health care service quality, it could also be argued that their main function is to quantify perceptions. The importance of assessing patient satisfaction in individuals’ own language has been highlighted in research. However, important culture-specific differences can be revealed during the adaptation process of a scale, and if not attended to can influence the validity ofthe scale.Objectives: The aim of this study was to assess the validity and reliability of the isiXhosa version of the Patient Survey for Quality of Care (PSQC) in primary health care (PHC) facilities in a selected district in the Western Cape, South Africa.Method: The PSQC was translated into isiXhosa by two independant translators and the translated back into English by a third translator. All three translators reviewed the back translation. Face and content validity of the scale were assessed. Fifteen isiXhosa-speaking clients with type 2 diabetes mellitus who had a mean age of 62.27 years (SD 10.33) and came from a randomly selected community health centre participated in the test-retest reliability.Results: Internal consistency of the scale was good (Cronbach alpha 0.70). Alpha values of individual items relating to quality of care as well as items flagged for inferior service quality were between 0.772 and 1.000, indicating good to high internal consistency.Conclusion: Results of this study indicated that the isiXhosa version of the PSQC was as reliable as the English version. It can be implemented at PHC level to assess isiXhosa-speaking patients’ satisfaction with health care services.

scholarly journals Implementation of a performance-based financing scheme in Malawi and resulting externalities on the quality of care of non-incentivized services

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephan Brenner ◽  
Caterina Favaretti ◽  
Julia Lohmann ◽  
Jobiba Chinkhumba ◽  
Adamson S. Muula ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Services ◽  
Antenatal Care ◽  
Service Provision ◽  
Child Health Services ◽  
Negative Externalities ◽  
Positive Externalities ◽  
Performance Based Financing ◽  
A Performance

Abstract Background Countries in Africa progressively implement performance-based financing schemes to improve the quality of care provided by maternal, newborn and child health services. Beyond its direct effects on service provision, evidence suggests that performance-based financing can also generate positive externalities on service utilization, such as increased use of those services that reached higher quality standards after effective scheme implementation. Little, however, is known about externalities generated within non-incentivized health services, such as positive or negative effects on the quality of services within the continuum of maternal care. Methods We explored whether a performance-based financing scheme in Malawi designed to improve the quality of childbirth service provision resulted positive or negative externalities on the quality of non-targeted antenatal care provision. This non-randomized controlled pre-post-test study followed the phased enrolment of facilities into a performance-based financing scheme across four districts over a two-year period. Effects of the scheme were assessed by various composite scores measuring facilities’ readiness to provide quality antenatal care, as well as the quality of screening, prevention, and education processes offered during observed antenatal care consultations. Results Our study did not identify any statistically significant effects on the quality of ANC provision attributable to the implemented performance-based financing scheme. Our findings therefore suggest not only the absence of positive externalities, but also the absence of any negative externalities generated within antenatal care service provision as a result of the scheme implementation in Malawi. Conclusions Prior research has shown that the Malawian performance-based financing scheme was sufficiently effective to improve the quality of incentivized childbirth service provision. Our findings further indicate that scheme implementation did not affect the quality of non-incentivized but clinically related antenatal care services. While no positive externalities could be identified, we also did not observe any negative externalities attributable to the scheme’s implementation. While performance-based incentives might be successful in improving targeted health care processes, they have limited potential in producing externalities – neither positive nor negative – on the provision quality of related non-incentivized services.

scholarly journals Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hannah Maria Jennings ◽  
Joanna Morrison ◽  
Kohenour Akter ◽  
Hassan Haghparast-Bidgoli ◽  
Carina King ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Care Providers ◽  
Low Income ◽  
Diabetes Management ◽  
Local Health ◽  
Care Seeking ◽  
Care Providers ◽  
Structured Interviews ◽  
Rural Bangladesh

Abstract Background Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered. Methods Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient. Results People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence. Conclusion People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care. Trial registration ISRCTN41083256. Registered on 30/03/2016.

Content of antenatal care and perception about services provided by primary hospitals in Nepal: a convergent mixed methods study

2021 ◽  
Vol 33 (2) ◽  
Author(s):  
Yubraj Acharya ◽  
Nigel James ◽  
Rita Thapa ◽  
Saman Naz ◽  
Rishav Shrestha ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Mixed Methods ◽  
Antenatal Care ◽  
Quality Care ◽  
National Level ◽  
Poor Quality ◽  
Public Hospitals ◽  
World Health ◽  
Outcome Variable

Abstract Background Nepal has made significant strides in maternal and neonatal mortality over the last three decades. However, poor quality of care can threaten the gains, as maternal and newborn services are particularly sensitive to quality of care. Our study aimed to understand current gaps in the process and the outcome dimensions of the quality of antenatal care (ANC), particularly at the sub-national level. We assessed these dimensions of the quality of ANC in 17 primary, public hospitals across Nepal. We also assessed the variation in the ANC process across the patients’ socio-economic gradient. Methods We used a convergent mixed methods approach, whereby we triangulated qualitative and quantitative data. In the quantitative component, we observed interactions between providers (17 hospitals from all 7 provinces) and 198 women seeking ANC and recorded the tasks the providers performed, using the Service Provision Assessments protocol available from the Demographic and Health Survey program. The main outcome variable was the number of tasks performed by the provider during an ANC consultation. The tasks ranged from identifying potential signs of danger to providing counseling. We analyzed the resulting data descriptively and assessed the relationship between the number of tasks performed and users’ characteristics. In the qualitative component, we synthesized users’ and providers’ narratives on perceptions of the overall quality of care obtained through focus group discussions and in-depth interviews. Results Out of the 59 tasks recommended by the World Health Organization, providers performed only 22 tasks (37.3%) on average. The number of tasks performed varied significantly across provinces, with users in province 3 receiving significantly higher quality care than those in other provinces. Educated women were treated better than those with no education. Users and providers agreed that the overall quality of care was inadequate, although providers mentioned that the current quality was the best they could provide given the constraints they faced. Conclusion The quality of ANC in Nepal’s primary hospitals is poor and inequitable across education and geographic gradients. While current efforts, such as the provision of 24/7 birthing centers, can mitigate gaps in service availability, additional equipment, infrastructure and human resources will be needed to improve quality. Providers also need additional training focused on treating patients from different backgrounds equally. Our study also points to the need for additional research, both to document the quality of care more objectively and to establish key determinants of quality to inform policy.

scholarly journals Optimizing Quality of Care and Patient Safety in Malaysia: The Current Global Initiatives, Gaps and Suggested Solutions

2015 ◽  
Vol 8 (6) ◽  
pp. 75 ◽  
Author(s):  
Mu'taman Jarrar ◽  
Hamzah Abdul Rahman ◽  
Mohammad Sobri Don
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Health Plan ◽  
Care Service ◽  
Health Care Service ◽  
Working Environment ◽  
Annual Reports ◽  
Related Factors ◽  
Global Initiatives

<p><strong>BACKGROUND &amp; OBJECTIVE:</strong> Demand for health care service has significantly increased, while the quality of healthcare has become both a national and an international priority. This paper aims to identify the gaps and the current initiatives for optimizing the quality of care and patient safety in Malaysia.</p><p><strong>DESIGN:</strong> A narrative review of the literature. Highly cited articles were used as the basis to retrieve and review the current initiatives for optimizing the quality of care and patient safety. The country health plan of Ministry of Health (MOH) and the MOH Annual Reports in Malaysia were reviewed.</p><p><strong>RESULTS: </strong>The MOH has set four strategies for optimizing quality and sustaining quality of life. The 10<sup>th</sup> Malaysia Health Plan promotes the theme “1 Care for 1 Malaysia” in order to sustain the quality of care. Despite of these efforts, the total number of complaints received by the medico-legal section of the MOH is increasing. The current global initiatives indicted that quality performance generally belong to three main categories: patient; staffing; and working environment related factors.</p><p><strong>CONCLUSION: </strong>There is no single intervention of optimizing quality of care to maintain patient safety. Multidimensional efforts and interventions are recommended in order to optimize the quality of care and patient safety in Malaysia.</p>

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