Integrated clinical and quality improvement coaching in Son La Province, Vietnam: a model of building public sector capacity for sustainable HIV care delivery.
Integrated clinical and quality improvement coaching in Son La Province, Vietnam: a model of building public sector capacity for sustainable HIV care delivery.
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DOI：
10.1186/s12913-015-0935-8
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发表时间：
2015-07-17
影响因子：
2.8
通讯作者：
Hirschhorn LR
中科院分区：
文献类型：
--
作者：
Cosimi LA;Dam HV;Nguyen TQ;Ho HT;Do PT;Duc DN;Nguyen HT;Gardner B;Libman H;Pollack T;Hirschhorn LR
在全球扩大抗逆转录病毒疗法包括广泛的培训和现场支助，以建设艾滋病毒保健工作者的能力。然而，旨在加强知识和技能的传统努力往往不能成功地缩小维持高质量护理所需的关键卫生系统的差距。我们培训和指导了孙拉省卫生厅和省艾滋病诊所的现有工作人员，作为一个省级教练团队（PCT），为该省的艾滋病诊所提供艾滋病临床技能和质量改进（QI）方面的综合教练。9个核心指标，通过图表提取的诊所和省级工作人员在基线和6个月的间隔后测量。从团队到每个诊所的QI和临床技能培训，都是由绩效测量结果、差距分析和由此产生的QI计划指导的。18个月后，PCT成功地推广了QI活动，并独立地为省综合医院诊所和该省8个地区诊所中的6个提供定期指导。教练的频率和类型由绩效测量结果决定。诊所平均完成了5个质量保证项目。所有诊所的艾滋病毒护理质量都得到了改善，其中七项指标显著提高。总体而言，在将该模型整合到越南国家QI计划中后，PCT活动和临床表现都得到了维持。我们成功地建立了一个公共部门卫生保健工作者团队的能力，以在全省范围内提供临床技能和QI的综合培训。PCT是一个可行和有效的模式，可以在分散的农村环境中推广和维持高质量的活动，改善艾滋病毒护理服务。
The global scale-up of antiretroviral therapy included extensive training and onsite support to build the capacity of HIV health care workers. However, traditional efforts aimed at strengthening knowledge and skills often are not successful at improving gaps in the key health systems required for sustaining high quality care. We trained and mentored existing staff of the Son La provincial health department and provincial HIV clinic to work as a provincial coaching team (PCT) to provide integrated coaching in clinical HIV skills and quality improvement (QI) to the HIV clinics in the province. Nine core indicators were measured through chart extraction by clinic and provincial staff at baseline and at 6 month intervals thereafter. Coaching from the team to each of the clinics, in both QI and clinical skills, was guided by results of performance measurements, gap analyses, and resulting QI plans. After 18 months, the PCT had successfully spread QI activities, and was independently providing regular coaching to the provincial general hospital clinic and six of the eight district clinics in the province. The frequency and type of coaching was determined by performance measurement results. Clinics completed a mean of five QI projects. Quality of HIV care was improved throughout all clinics with significant increases in seven of the indicators. Overall both the PCT activities and clinic performance were sustained after integration of the model into the Vietnam National QI Program. We successfully built capacity of a team of public sector health care workers to provide integrated coaching in both clinical skills and QI across a province. The PCT is a feasible and effective model to spread and sustain quality activities and improve HIV care services in a decentralized rural setting.