Effectiveness of collaborative improvement: evidence from 27 applications in 12 less-developed and middle-income countries
Effectiveness of collaborative improvement: evidence from 27 applications in 12 less-developed and middle-income countries
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DOI：
10.1136/bmjqs.2010.044388
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发表时间：
2011-08-01
影响因子：
5.4
通讯作者：
Marquez, Lani
中科院分区：
文献类型：
--
作者：
Franco, Lynne Miller;Marquez, Lani
简介：在发达国家，改进协作方法作为推广临床实践的有效方法得到了广泛推广，但很少有关于其在发展中国家环境中的有效性的报道。1998年至2008年期间，美国国际开发署资助了14个中低收入国家的54个协作项目，并对资源有限的环境采用了这一方法。作者分析了来自12个国家的27个合作机构的符合研究纳入标准的供应商遵守标准和结果的数据（至少有12个月的数据可供分析，指标以百分比计量）。该数据集代表1 338个基于设施的小组，由135个与孕产妇、新生儿和儿童健康、艾滋病毒/艾滋病、计划生育、疟疾和结核病有关的时间序列图表组成。平均28个月的数据可用于每个charts.Results：87%的这些图表达到80%或更高的性能水平，76%达到至少90%的性能，即使三分之二的基线性能低于50%。每个图表的团队平均增长了51.9个百分点（SE=28.0），基线值是绝对增长的主要决定因素。团队持续保持这一水平的表现平均为13个月（69%的观察月）。达到80%的性能的平均时间为9.2个月（SE 8.5），并达到90%的性能，14.4个月（SE=12.0）。结论：协同改进可以产生显着的，持续的收益符合标准和成果，在欠发达的环境，值得更广泛的应用作为战略，加强卫生系统。
Introduction: The improvement collaborative approach has been widely promoted in developed countries as an effective method to spread clinical practices, but little has been published on its effectiveness in developing country settings. Between 1998 and 2008, the United States Agency for International Development funded 54 collaboratives in 14 low- and middle-income countries, adapting the approach to resource-constrained environments.Methods: The authors analysed data on provider compliance with standards and outcomes from 27 collaboratives in 12 countries that met study inclusion criteria (at least 12 months of data available for analysis and indicators measured as percentages). The dataset, representing 1338 facility-based teams, consisted of 135 time-series charts related to maternal, newborn and child health, HIV/AIDS, family planning, malaria and tuberculosis. An average of 28 months of data was available for each chart.Results: Eighty-seven per cent of these charts achieved performance levels of 80% or higher, and 76% reached at least 90% performance, even though two-thirds had a baseline performance below 50%. Teams achieved average increases of 51.9 percentage points (SE=28.0) per chart, with baseline value being the main determinant of absolute increase. Teams consistently maintained this level of performance for an average of 13 months (69% of months of observation). The average time to reach 80% performance was 9.2 months (SE 8.5), and to reach 90% performance, 14.4 months (SE=12.0).Conclusion: Collaborative improvement can produce significant, sustained gains in compliance with standards and outcomes in less-developed settings and merits wider application as a strategy for health systems strengthening.