Use of standardised patients to assess quality of healthcare in Nairobi, Kenya: a pilot, cross-sectional study with international comparisons.
Use of standardised patients to assess quality of healthcare in Nairobi, Kenya: a pilot, cross-sectional study with international comparisons.
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DOI：
10.1136/bmjgh-2017-000333
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发表时间：
2017
影响因子：
8.1
通讯作者：
Das J
中科院分区：
文献类型：
--
作者：
Daniels B;Dolinger A;Bedoya G;Rogo K;Goicoechea A;Coarasa J;Wafula F;Mwaura N;Kimeu R;Das J
使用标准化患者（SP）可以在多个环境中可靠地测量临床护理质量，但这种方法尚未在撒哈拉以南非洲地区广泛使用。本研究验证了使用SP的各种示踪剂的条件下，在内罗毕，肯尼亚，并提供了新的结果，在抽样的初级保健诊所的护理质量。我们在私人和公共诊所部署了14个SP，这些SP表现为哮喘、儿童腹泻、肺结核或不稳定型心绞痛。与卫生部联合制定了病例管理准则和清单。我们根据SP避免检测或危险情况的能力验证了SP方法，而不会给提供商带来大量时间负担。我们还评估了SP特性的质量措施的敏感性。我们通过遵守整个样本的指南和检查表来评估实践质量，按病例分层和按部门分层，并与先前公布的印度城市，印度农村和中国农村的结果进行比较。在42个设施的166次互动中，检测率和暴露于不安全条件的情况均为零。没有检测到与SP特征的结果相关性，这将使结果产生偏倚。在所有四种条件下，53%的SP被正确管理，在示踪剂条件下变化很大。SP在公立诊所支付的费用少76%，但正确管理的比例在三个条件下与私人诊所相似，在第四个条件下更高。除了心绞痛病例外，肯尼亚的结果优于印度和中国。SP方法在肯尼亚城市环境中用于临床实践评估是安全有效的。试点结果表明，在这种情况下，公共提供者提供了类似的正确管理率，以显着降低病人的自付费用的私人提供者。然而，各国之间的比较对所考虑的示踪剂条件很敏感。
The quality of clinical care can be reliably measured in multiple settings using standardised patients (SPs), but this methodology has not been extensively used in Sub-Saharan Africa. This study validates the use of SPs for a variety of tracer conditions in Nairobi, Kenya, and provides new results on the quality of care in sampled primary care clinics. We deployed 14 SPs in private and public clinics presenting either asthma, child diarrhoea, tuberculosis or unstable angina. Case management guidelines and checklists were jointly developed with the Ministry of Health. We validated the SP method based on the ability of SPs to avoid detection or dangerous situations, without imposing a substantial time burden on providers. We also evaluated the sensitivity of quality measures to SP characteristics. We assessed quality of practice through adherence to guidelines and checklists for the entire sample, stratified by case and stratified by sector, and in comparison with previously published results from urban India, rural India and rural China. Across 166 interactions in 42 facilities, detection rates and exposure to unsafe conditions were both zero. There were no detected outcome correlations with SP characteristics that would bias the results. Across all four conditions, 53% of SPs were correctly managed with wide variation across tracer conditions. SPs paid 76% less in public clinics, but proportions of correct management were similar to private clinics for three conditions and higher for the fourth. Kenyan outcomes compared favourably with India and China in all but the angina case. The SP method is safe and effective in the urban Kenyan setting for the assessment of clinical practice. The pilot results suggest that public providers in this setting provide similar rates of correct management to private providers at significantly lower out-of-pocket costs for patients. However, comparisons across countries are sensitive to the tracer condition considered.
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影响因子：
5.4
作者：
Madden, JM;Quick, JD;Kafle, KK
通讯作者：
Kafle, KK
影响因子：
5
作者：
Leonard, Kenneth L.;Masatu, Melkiory C.
通讯作者：
Masatu, Melkiory C.
DOI：
10.1016/s1473-3099(15)00077-8
发表时间：
2015-11
期刊：
The Lancet. Infectious diseases
影响因子：
--
作者：
Das J;Kwan A;Daniels B;Satyanarayana S;Subbaraman R;Bergkvist S;Das RK;Das V;Pai M
通讯作者：
Pai M
影响因子：
10.7
作者：
Das, Jishnu;Holla, Alaka;Muralidharan, Karthik
通讯作者：
Muralidharan, Karthik
影响因子：
3.2
作者：
Friedman, Willa;Woodman, Benjamin;Chatterji, Minki
通讯作者：
Chatterji, Minki