Use of standardised patients to assess quality of tuberculosis care: a pilot, cross-sectional study.
Use of standardised patients to assess quality of tuberculosis care: a pilot, cross-sectional study.
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DOI：
10.1016/s1473-3099(15)00077-8
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发表时间：
2015-11
期刊：
影响因子：
--
通讯作者：
Pai M
中科院分区：
文献类型：
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作者：
Das J;Kwan A;Daniels B;Satyanarayana S;Subbaraman R;Bergkvist S;Das RK;Das V;Pai M
现有关于结核病护理质量的研究大多反映了知识，而不是实际实践。我们进行了一项关于使用标准化患者（SP）评估结核病护理质量的验证研究。17个服务提供者提出了4例病例，其中2例为推定结核病，1例为确诊结核病和疑似耐多药结核病，德里100名同意提供者之间有250次服务提供者互动，包括合格（29%）、替代医学（40%）和非正式提供者（31%）。验证标准为：（1）提供商和SP的风险和避免不良事件的能力可忽略不计;（2）提供商对SP的检测率低，以及（3）SP之间的数据准确性和SP召回的音频验证。我们使用医学插图来评估提供者对假定结核病的知识。采用印度结核病护理标准（STCI）对正确的病例管理进行基准测试。SP的检出率较低（232次互动中的4.7%），回忆与录音的相关性较高（r=0.63; 95%CI：0.53 - 0.79），且无安全性问题。平均咨询时间为6分钟，完成6.2个问题/检查，占基本检查表项目的35%（95%置信区间[CI]：33%-38%）。在所有病例中，250例中只有52例（21%; 95% CI：16%-26%）得到正确管理。MBBS医生的正确管理率高于其他所有医生（调整后OR=2.41，95%CI：1.17-4.93）。供应商的知识在小插曲是显着更符合STCI比他们的做法。SP方法可以成功地用于评估结核病护理。我们的数据表明，供应商的知识和实践之间存在很大差距。
Existing studies on quality of tuberculosis care mostly reflect knowledge, not actual practice. We conducted a validation study on the use of standardized patients (SPs) for assessing quality of TB care. Four cases, two for presumed TB and one each for confirmed TB and suspected MDR-TB, were presented by 17 SPs, with 250 SP interactions among 100 consenting providers in Delhi, including qualified (29%), alternative medicine (40%) and informal providers (31%). Validation criteria were: (1) negligible risk and ability to avoid adverse events for providers and SPs; (2) low detection rates of SPs by providers, and (3) data accuracy across SPs and audio verification of SP recall. We used medical vignettes to assess provider knowledge for presumed TB. Correct case management was benchmarked using Standards for TB Care in India (STCI). SPs were deployed with low detection rates (4.7% of 232 interactions), high correlation of recall with audio recordings (r=0.63; 95% CI: 0.53 – 0.79), and no safety concerns. Average consultation length was 6 minutes with 6.2 questions/exams completed, representing 35% (95% confidence interval [CI]: 33%–38%) of essential checklist items. Across all cases, only 52 of 250 (21%; 95% CI: 16%–26%) were correctly managed. Correct management was higher among MBBS doctors (adjusted OR=2.41, 95% CI: 1.17–4.93) as compared to all others. Provider knowledge in the vignettes was markedly more consistent with STCI than their practice. The SP methodology can be successfully implemented to assess TB care. Our data suggest a big gap between provider knowledge and practice.