Protocol-driven primary care and community linkages to improve population health in rural Zambia: the Better Health Outcomes through Mentoring and Assessment (BHOMA) project
Protocol-driven primary care and community linkages to improve population health in rural Zambia: the Better Health Outcomes through Mentoring and Assessment (BHOMA) project
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DOI：
10.1186/1472-6963-13-s2-s7
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发表时间：
2013-05-31
影响因子：
2.8
通讯作者：
Chilengi, Roma
中科院分区：
文献类型：
--
作者：
Stringer, Jeffrey S. A.;Chisembele-Taylor, Angela;Chilengi, Roma
赞比亚资源不足的公共卫生系统如果不大幅加速降低死亡率，就无法实现与卫生有关的千年发展目标。降低死亡率不仅取决于增加获得保健的机会，而且取决于提高所提供保健的质量。我们的项目建议通过在设施和社区层面提供有针对性的质量改进（QI）干预来提高临床护理的质量并提高护理的利用率。实施情况说明：该项目正在实施42个初级保健设施，为赞比亚卢萨卡省45万多农村人口提供服务。我们已经部署了六个QI小组，在每个站点实施一致的临床协议、表格和系统。QI团队定义新的临床质量期望，并提供实现这些期望所需的工具。他们还监督所提供的护理，并指导设施工作人员提高护理质量。我们还聘请社区卫生工作者积极转诊和随访患者。评估设计：项目实施在四年的时间里，每三个月随机选择六个新设施进行逐步扩展。三次年度住户调查将确定在实施之前、期间和之后每个社区年龄标准化死亡率和5岁以下儿童死亡率的人口估计数。调查还将提供儿童疫苗覆盖率、孕期护理利用和一般成人健康的措施。卫生设施调查将评估初级卫生干预措施的覆盖面和卫生系统有效性措施。讨论：患者与提供者的互动是社区与卫生系统相遇的重要界面。我们的项目旨在通过大幅度改善这种相互作用来降低人口死亡率。我们的成功将取决于指导的能力和持续改善临床服务质量的能力。同样至关重要的是，一旦服务的质量得到改善，越来越多的人口将认识到它们的价值并开始利用它们。
Introduction: Zambia's under-resourced public health system will not be able to deliver on its health-related Millennium Development Goals without a substantial acceleration in mortality reduction. Reducing mortality will depend not only upon increasing access to health care but also upon improving the quality of care that is delivered. Our project proposes to improve the quality of clinical care and to improve utilization of that care, through a targeted quality improvement (QI) intervention delivered at the facility and community level.Description of implementation: The project is being carried out 42 primary health care facilities that serve a largely rural population of more than 450,000 in Zambia's Lusaka Province. We have deployed six QI teams to implement consensus clinical protocols, forms, and systems at each site. The QI teams define new clinical quality expectations and provide tools needed to deliver on those expectations. They also monitor the care that is provided and mentor facility staff to improve care quality. We also engage community health workers to actively refer and follow up patients.Evaluation design: Project implementation occurs over a period of four years in a stepped expansion to six randomly selected new facilities every three months. Three annual household surveys will determine population estimates of age-standardized mortality and under-5 mortality in each community before, during, and after implementation. Surveys will also provide measures of childhood vaccine coverage, pregnancy care utilization, and general adult health. Health facility surveys will assess coverage of primary health interventions and measures of health system effectiveness.Discussion: The patient-provider interaction is an important interface where the community and the health system meet. Our project aims to reduce population mortality by substantially improving this interaction. Our success will hinge upon the ability of mentoring and continuous QI to improve clinical service delivery. It will also be critical that once the quality of services improves, increasing proportions of the population will recognize their value and begin to utilize them.