Shedding light on quality of care: a study protocol for a randomized trial evaluating the impact of the Solar Suitcase in rural health facilities on maternal and newborn care quality in Uganda

In this article, we describe the results of a rapid qualitative study conducted between May 19 and June 25, 2020 on the work experience of midwives during the first wave of the COVID-19 pandemic in Brussels and Wallonia (Belgium). Using semi-structured interviews conducted with fifteen midwives working in hospitals or practicing privately, we investigated the impact of the first COVID-19 wave on their work experience, the woman-midwife relationship, and midwife-perceived changes in quality of care. Findings include high levels of stress and insecurity related to the lack of resources and personal protective equipment, feelings of distrust from midwives towards the Belgian State and public health authorities, as well as structural and organizational challenges within maternity wards which negatively affected quality of care. Moreover, based on the midwives' experiences, we demonstrate the need to recognise the views of all stakeholders involved in maternal and newborn care provision, and share five essential lessons learned from this study: 1) it is crucial to acknowledge the central role of midwives for maintaining maternal and newborn care amidst the pandemic and beyond; 2) creating unified national guidelines could support ensuring best practice; 3) efforts must be put in place to diminish the climate of mistrust towards health authorities and to repair the relationship between midwives and decision-makers which was damaged during the pandemic; 4) caring for front-line healthcare workers' mental health is critical, and 5) quality of maternal care can be improved, even in the midst of a pandemic, through team effort and creative solutions tailored to the needs and demands of each setting.

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Protocol: Improving Access to Specialist Nephrology Care Among Rural/Remote Dwellers of Alberta: The Role of Electronic Consultation in Improving Care for Patients With Chronic Kidney Disease

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358119878715 ◽

2019 ◽

Vol 6 ◽

pp. 205435811987871

Author(s):

Aminu Bello ◽

Deenaz Zaidi ◽

Branko Braam ◽

Mark Courtney ◽

Jodi Glassford ◽

...

Keyword(s):

Quality Of Care ◽

Access To Care ◽

Care Delivery ◽

Care Quality ◽

Care Providers ◽

Practice Facilitation ◽

Specialist Care ◽

Nephrology Care ◽

The Impact

Background: As the burden of chronic kidney disease (CKD) continues to increase, many geographically dispersed Canadians have limited access to specialist nephrology care, which tends to be centralized in major urban areas. As a result, many rural/remote-dwellers in Canada experience poor quality of care and related adverse outcomes. It is imperative to develop alternative care delivery mechanisms to ensure optimal health outcomes for all Canadians. Objective: To investigate the feasibility and effectiveness of electronic consultation (eConsult) as a new model for interactions between specialists and primary care providers (PCPs) to improve access to care for patients with CKD. Design: This is a sequential, mixed methods study that will be conducted in 3 phases. Setting: The study will be conducted across the entire province of Alberta, supported by Alberta Kidney Care (formerly, Northern and Southern Alberta Renal Programs [NARP/SARP]). Patients: Patients suffering from CKD will be included in the study. Measurements: We will assess the barriers and enablers of implementation and adoption of an e-consultation protocol to facilitate access to care for patients with CKD in Alberta with a focus on rural/remote-dwellers with CKD. We will also evaluate the impact of the eConsult system (eg, improved access to specialist care, reduction in care gaps), assess the feasibility of province-wide implementation, and compare eConsult with practice facilitation versus eConsult alone in terms of access to specialist care, quality of care, and related outcomes. Methods: The study will be conducted in 3 phases. In phase 1, we will assess the perceptions of stakeholders (ie, PCPs, nephrologists, patients, policymakers, and other care providers) to improve CKD care delivery, quality, and outcomes in Alberta with focus groups and semistructured interviews. Phase 2 will engage specific family physicians for their input on key factors and logistical issues affecting the feasibility of implementing eConsult for the care of patients with CKD. Phase 3 will provide academic detailing including practice facilitation to clinics in Alberta to assess how eConsult with practice facilitation compares with eConsult alone in terms of access to specialist care, quality of care, and related outcomes. Results: We will assess stakeholder perceptions about potential barriers to and enablers of a new eConsult and decision support system strategy, focusing on elements that are most important for the design of a feasible and implementable intervention. We will develop, pilot test, and assess the impact of the eConsult model in improving access to specialist nephrology care and the feasibility of province-wide implementation. The final phase of the project will address key challenges for optimal care for patients with CKD living in rural, remote, and underserved areas of Alberta, particularly timely referral and disease management as well as the cost-effective benefits of eConsult. Limitations: Lack of high-speed Internet in many rural and remote areas of Alberta may lead to more time spent in completing the eConsult request online versus faxing a referral the traditional way. Allied health care staff (referral coordinators, administrative staff) require training to the eConsult system, and physicians at many remote sites do not have adequate staff to handle eConsult as an added task. Conclusions: Implementation of eConsult can favorably influence referral patterns, access to care, care quality, patient outcomes, and health care costs for people with CKD. Results of this study will inform the optimization of care for rural/remote-dwellers with CKD and will facilitate future partnerships with policymakers and provincial renal programs in Alberta to ensure optimal kidney health for all residents. Trial registration: Not required.

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Randomized trial assessing the impact of survivorship care plans on the quality of care for childhood cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.15_suppl.10007 ◽

2016 ◽

Vol 34 (15_suppl) ◽

pp. 10007-10007

Author(s):

Cary Philip Gross ◽

Wilhelmenia Lee Ross ◽

Jaime L. Rotatori ◽

Hannah-Rose Mitchell ◽

Xiaomei Ma ◽

...

Keyword(s):

Quality Of Care ◽

Cancer Survivors ◽

Randomized Trial ◽

Childhood Cancer ◽

Childhood Cancer Survivors ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Care Plans ◽

The Impact

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Measuring Quality of Maternal and Newborn Care in Developing Countries Using Demographic and Health Surveys

PLoS ONE ◽

10.1371/journal.pone.0157110 ◽

2016 ◽

Vol 11 (6) ◽

pp. e0157110 ◽

Cited By ~ 6

Author(s):

Zoe Dettrick ◽

Hebe N. Gouda ◽

Andrew Hodge ◽

Eliana Jimenez-Soto

Keyword(s):

Developing Countries ◽

Health Surveys ◽

Newborn Care ◽

Demographic And Health Surveys ◽

Maternal And Newborn Care ◽

Maternal And Newborn

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Does Investor-Ownership of Nursing Homes Compromise the Quality of Care?

International Journal of Health Services ◽

10.2190/ebcn-wecv-c0nt-676r ◽

2002 ◽

Vol 32 (2) ◽

pp. 315-325 ◽

Cited By ~ 32

Author(s):

Charlene Harrington ◽

Steffie Woolhandler ◽

Joseph Mullan ◽

Helen Carrillo ◽

David U. Himmelstein

Keyword(s):

Quality Of Care ◽

Nursing Homes ◽

Skilled Nursing Facility ◽

Nurse Staffing ◽

Care Quality ◽

Nursing Facilities ◽

Skilled Nursing ◽

Staffing Ratios ◽

The Impact

Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories (“quality of care,” “quality of life,” and “other”) and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.

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The Impact of Primary Care Dual-Management on Quality of Care

Journal of Primary Care & Community Health ◽

10.1177/2150131911411194 ◽

2011 ◽

Vol 3 (1) ◽

pp. 11-16 ◽

Cited By ~ 1

Author(s):

Peter J. Kaboli ◽

Daniel M. Shivapour ◽

Michael S. Henderson ◽

Areef Ishani ◽

Mary E. Charlton

Keyword(s):

Primary Care ◽

Quality Of Care ◽

Hemoglobin A1c ◽

Ldl Cholesterol ◽

Primary Care Providers ◽

Care Quality ◽

Care Providers ◽

Dual Management ◽

The Impact

Background: Discontinuity is common in US healthcare. Patients access multiple systems of care and in the nation’s largest integrated healthcare system, Veteran’s Administration (VA) patients frequently use non-VA primary care providers. The impact of this “dual-management” on quality is unknown. The authors’ objective was to identify dual-management and associations with markers of care quality for hypertension and associated conditions. Methods: Data was collected via surveys and chart reviews of primary care patients with hypertension from six VA clinics in Iowa and Minnesota. Clinical measures abstracted included the following: goal blood pressure (BP) and use of guideline-concordant therapy, low-density lipoprotein (LDL) cholesterol, hemoglobin A1C, and body mass index (BMI). Dual-management data was obtained through self-report. Results: Of 189 subjects (mean age = 66), 36% were dual-managed by non-VA providers. There was no difference in hypertension quality of care measures by dual-management status. A total of 51% were at BP goal and 58% were on guideline-concordant therapy. Dual-managed patients were more likely to use thiazide diuretics (43% vs 29%; P = .03) and angiotensin receptor blockers (13% vs 3%; P < .01), but less likely to use angiotensin-converting enzyme inhibitors (43% vs 61%; P = .02). There was no difference in LDL cholesterol (97.1 mg/dl vs 100.1 mg/dl; P = .55), hemoglobin A1C (7% vs 6%; P = .74), or BMI (29.8 vs 30.9; P = .40) for dual-managed versus VA managed patients, respectively. Conclusions: Although dual-management may decrease continuity, VA/private sector dual-management did not impact quality of care, though some medication differences were observed. With the high prevalence of dual-management, future work should further address quality and evaluate redundancy of services.

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The impact of COVID-19 on the provision of respectful maternity care: findings from a global survey of health workers

10.1101/2021.05.05.21256667 ◽

2021 ◽

Author(s):

Anteneh Asefa ◽

Aline Semaan ◽

Therese Delvaux ◽

Elise Huysmans ◽

Anna Galle ◽

...

Keyword(s):

Quality Of Care ◽

Maternity Care ◽

Qualitative Data ◽

Health Workers ◽

Qualitative Content Analysis ◽

Standards Of Care ◽

Respectful Maternity Care ◽

The Impact ◽

Maternal And Newborn

Background Significant adjustments to the provision of maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care. Aim To explore how the COVID-19 pandemic affected frontline health workers' ability to provide respectful maternity care globally. Methods We conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected quantitative and qualitative data between July and December 2020 and conducted a qualitative content analysis to explore open-ended responses. Findings Health workers (n=1,127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers' fear of getting infected and measures taken to minimise COVID-19 transmission. Discussion Multidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term. Conclusions The measures taken during the COVID-19 pandemic disrupted the quality of care provided to women during labour and childbirth generally, and respectful maternity care specifically. Keywords Maternal health; Quality of care; Labour; Childbirth; Newborn health; Intrapartum care, Antenatal care, Postnatal care

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Assessing capacity of health facilities to provide routine maternal and newborn care in low-income settings: what proportions are ready to provide good-quality care, and what proportions of women receive it?

10.21203/rs.2.19609/v1 ◽

2019 ◽

Author(s):

Keith Tomlin ◽

Della Berhanu ◽

Meenakshi Gautham ◽

Nasir Umar ◽

Joanna Schellenberg ◽

...

Keyword(s):

Low Income ◽

Quality Care ◽

Newborn Care ◽

Uttar Pradesh ◽

Routine Care ◽

Health Facilities ◽

Signal Functions ◽

Maternal And Newborn Care ◽

Maternal And Newborn

Abstract Background Good quality maternal and newborn care at primary health facilities is essential for both mothers and infants, but in settings with high maternal and newborn mortality the evidence for the protective effect of facility delivery is inconsistent. We surveyed samples of health facilities in three settings with high maternal mortality, to assess the quality of routine maternal and newborn care and the proportion of women delivering in facilities with a good standard of care. Surveys were conducted in 2012 and 2015 to assess changes in the quality of care over time. Methods Surveys were conducted in Ethiopia, the Indian state of Uttar Pradesh and Gombe State in North-Eastern Nigeria. 166 and 305 primary care facilities were sampled in 2012 and 2015 respectively. In each year we assessed whether each facility could provide four “signal” functions of routine maternal and newborn care. From facility registers we counted the number of deliveries in the previous six months and calculated the proportion of women giving birth in facilities which could offer good quality routine care. Results In Ethiopia the proportion of deliveries in facilities which provided all four signal functions rose from 40% (95% CI 26-57) in 2012 to 43% (95% CI 31-56) in 2015. In Uttar Pradesh in 2012 an estimated 4% (95% CI 1-24) of facility deliveries occurred in facilities which provided all four signal functions, rising to 39% (95% CI 25-55) in 2015. In Nigeria these estimates were 25% (95% CI 6-66) and zero for 2012 and 2015 respectively. Improvements in signal functions in Ethiopia and Uttar Pradesh were led by improved supplies of commodities while Nigeria experienced declines in supplies of commodities and the number of Skilled Birth Attendants employed. Conclusions This study quantifies how health facilities can provide sub-optimal maternal and newborn care, and may help explain inconsistent outcomes of health facility care in some settings. Signal function methodology can provide a rapid and inexpensive measure of the capacity of facilities to provide such care. Incorporating data on facility deliveries and repeating the analyses highlights the adjustments that could have greatest impact upon maternal and newborn care.

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Randomized trial of care management to improve Parkinson disease care quality

Neurology ◽

10.1212/wnl.0000000000007324 ◽

2019 ◽

Vol 92 (16) ◽

pp. e1831-e1842 ◽

Cited By ~ 15

Author(s):

Karen I. Connor ◽

Eric M. Cheng ◽

Frances Barry ◽

Hilary C. Siebens ◽

Martin L. Lee ◽

...

Keyword(s):

Quality Of Care ◽

Parkinson Disease ◽

Usual Care ◽

Randomized Trial ◽

Care Management ◽

Chronic Care ◽

Care Quality ◽

Patient Centered ◽

Secondary Outcomes

ObjectiveTo test effects on care quality of Chronic Care Model-based Parkinson disease (PD) management.MethodsThis 2-group stratified randomized trial involved 328 veterans with PD in southwestern United States. Guided care management, led by PD nurses, was compared to usual care. Primary outcomes were adherence to 18 PD care quality indicators. Secondary outcomes were patient-centered outcome measures. Data sources were telephone survey and electronic medical record (EMR). Outcomes were analyzed as intent-to-treat comparing initial and final survey and repeated-measures mixed-effects models.ResultsAverage age was 71 years; 97% of participants were male. Mean proportion of participants receiving recommended PD care indicators was significantly higher for the intervention than for usual care (0.77 vs 0.58) (mean difference 0.19, 95% confidence interval [CI] 0.16, 0.22). Of 8 secondary outcomes, the only significant difference of the changes over time was in the positive Patient Health Questionnaire–2 depression screen for intervention minus usual care (−11.52 [95% CI −20.42, −2.62]).ConclusionA nurse-led chronic care management intervention, Care Coordination for Health Promotion and Activities in Parkinson's Disease (CHAPS), substantially increased adherence to PD quality of care indicators among veterans with PD, as documented in the EMR. Of 8 secondary outcomes assessed, a screening measure for depressive symptomatology was the only measure that was better in the intervention compared to usual care. More telephone calls in CHAPS were the only utilization difference over usual care. While CHAPS appears promising for improving PD care, additional iterative research is needed to refine the CHAPS model in routine clinical care so that it measurably improves patient-centered outcomes (NCT01532986).Classification of evidenceThis study provides Class I evidence that for patients with PD, CHAPS increased adherence to PD quality of care indicators.

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