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Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda.

Hanson C, Waiswa P, Marchant T, Marx M, Manzi F, Mbaruku G, Rowe A, Tomson G, Schellenberg J, Peterson S, EQUIP Study Te - Implement Sci (2014)

Bottom Line: Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities.The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings.PACTR201311000681314.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. claudia.hanson@ki.se.

ABSTRACT

Background: Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda.

Methods: In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys.

Discussion: EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings.

Trial registration: PACTR201311000681314.

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Related in: MedlinePlus

Model of improvement (adapted from Institute for Healthcare Improvement. The Breakthrough Series, 2003 [19]).
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Figure 2: Model of improvement (adapted from Institute for Healthcare Improvement. The Breakthrough Series, 2003 [19]).

Mentions: To implement the quality improvement process in a way that can more rapidly find solutions to difficult obstacles and scale-up improvement in multiple health facilities (or other sites), EQUIP uses the collaborative model for improvement (Figure 2) [19,29]. This model brings together QITs from multiple sites to work on the same obstacle. Action periods, lasting several months—when QITs are using PDSA cycles in their sites to test change ideas—alternate with learning sessions—one-day workshops when QITs meet to compare results and work towards developing a change idea that can be used across all sites. The EQUIP study team provides coaching and mentoring during action periods and facilitates the learning sessions (find details in Annex II).


Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda.

Hanson C, Waiswa P, Marchant T, Marx M, Manzi F, Mbaruku G, Rowe A, Tomson G, Schellenberg J, Peterson S, EQUIP Study Te - Implement Sci (2014)

Model of improvement (adapted from Institute for Healthcare Improvement. The Breakthrough Series, 2003 [19]).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230245&req=5

Figure 2: Model of improvement (adapted from Institute for Healthcare Improvement. The Breakthrough Series, 2003 [19]).
Mentions: To implement the quality improvement process in a way that can more rapidly find solutions to difficult obstacles and scale-up improvement in multiple health facilities (or other sites), EQUIP uses the collaborative model for improvement (Figure 2) [19,29]. This model brings together QITs from multiple sites to work on the same obstacle. Action periods, lasting several months—when QITs are using PDSA cycles in their sites to test change ideas—alternate with learning sessions—one-day workshops when QITs meet to compare results and work towards developing a change idea that can be used across all sites. The EQUIP study team provides coaching and mentoring during action periods and facilitates the learning sessions (find details in Annex II).

Bottom Line: Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities.The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings.PACTR201311000681314.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. claudia.hanson@ki.se.

ABSTRACT

Background: Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda.

Methods: In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys.

Discussion: EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings.

Trial registration: PACTR201311000681314.

Show MeSH
Related in: MedlinePlus