Quality improvement collaboratives as part of a quality improvement intervention package for preterm births at sub-national level in East Africa: a multi-method analysis.

Autor:	Mandu R; School of Public Health, Makerere University, Kampala, Kampala, Uganda., Miller L; Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA., Namazzi G; School of Public Health, Makerere University, Kampala, Kampala, Uganda., Twum-Danso N; Independent Consultant, New York, New York, USA., Achola KJA; Kenya Medical Research Institute, Nairobi, Kenya., Cooney I; Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA., Butrick E; Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA Elizabeth.butrick@ucsf.edu., Santos N; Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA., Masavah L; Kenya Medical Research Institute, Nairobi, Kenya., Nyakech A; Kenya Medical Research Institute, Nairobi, Kenya., Kirumbi L; Kenya Medical Research Institute, Nairobi, Kenya., Waiswa P; School of Public Health, Makerere University, Kampala, Kampala, Uganda.; Karolinska Institutet, Stockholm, Stockholm, Sweden., Walker D; Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA.; Department of Obstetrics and Gynecology and Global Health Sciences, University of California San Francisco Medical Center at Parnassus, San Francisco, California, USA.
Jazyk:	angličtina
Zdroj:	BMJ open quality [BMJ Open Qual] 2023 Dec 21; Vol. 12 (4). Date of Electronic Publication: 2023 Dec 21.
DOI:	10.1136/bmjoq-2023-002443
Abstrakt:	Background: Quality improvement collaboratives (QIC) are an approach to accelerate the spread and impact of evidence-based interventions across health facilities, which are found to be particularly successful when combined with other interventions such as clinical skills training. We implemented a QIC as part of a quality improvement intervention package designed to improve newborn survival in Kenya and Uganda. We use a multi-method approach to describe how a QIC was used as part of an overall improvement effort and describe specific changes measured and participant perceptions of the QIC. Methods: We examined QIC-aggregated run charts on three shared indicators related to uptake of evidence-based practices over time and conducted key informant interviews to understand participants' perceptions of quality improvement practice. Run charts were evaluated for change from baseline medians. Interviews were analysed using framework analysis. Results: Run charts for all indicators reflected an increase in evidence-based practices across both countries. In Uganda, pre-QIC median gestational age (GA) recording of 44% improved to 86%, while Kangaroo Mother Care (KMC) initiation went from 51% to 96% and appropriate antenatal corticosteroid (ACS) use increased from 17% to 74%. In Kenya, these indicators went from 82% to 96%, 4% to 74% and 4% to 57%, respectively. Qualitative results indicate that participants appreciated the experience of working with data, and the friendly competition of the QIC was motivating. The participants reported integration of the QIC with other interventions of the package as a benefit. Conclusions: In a QIC that demonstrated increased evidence-based practices, QIC participants point to data use, friendly competition and package integration as the drivers of success, despite challenges common to these settings such as health worker and resource shortages. Trial Registration Number: NCT03112018. Competing Interests: Competing interests: DW is the founder of PRONTO International, which led the team training element of the package. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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