Evaluation of a surgical supervision model in three African countries-protocol for a prospective mixed-methods controlled pilot trial
Evaluation of a surgical supervision model in three African countries-protocol for a prospective mixed-methods controlled pilot trial
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DOI：
10.1186/s40814-019-0409-6
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发表时间：
2019-02-18
影响因子：
1.7
通讯作者：
Gajewski, Jakub
中科院分区：
文献类型：
--
作者：
Pittalis, Chiara;Brugha, Ruairi;Gajewski, Jakub
如果准备充分并得到充分支持，区级医院（DLH）可以在为撒哈拉以南非洲农村人口提供基本外科服务方面发挥重要作用。本文介绍了非洲地区和农村人口扩大安全手术（SURG-Africa）项目的评估方案，该项目旨在加强马拉维、坦桑尼亚和赞比亚地区级医院（DLH）提供安全、高质量手术的能力。干预措施包括转诊医院的专家每季度对手术活跃的区级医院进行监督访问的方案，以及建立一个移动的电话咨询网络。总体目标是测试和完善该模式，以便推广到国家一级。方法采用混合方法对照的试点试验，检验所提出的监督模式在DLH实施质量保证手术中的可行性。首先，该研究将对地区设施的手术服务提供进行定量评估，了解医院的准备情况、容量和生产力，以及干预措施对这些方面的影响。其次，该研究将监测干预措施导致的从DLH到更高级别护理的转诊模式的变化。还将收集关于移动的支助网络利用情况的数据。该分析将比较干预医院和对照医院随时间的变化。本研究的第三个要素将涉及定性评估，以更好地了解DLH手术系统的功能以及这些功能如何受到干预的影响。它还将提供关于监督模式的可行性、影响和可持续性的进一步信息。讨论我们寻求通过专家的定期监督和移动的电话技术支持的咨询来测试地区一级能力建设的模式，以使目标国家的农村人口更容易获得、公平和可持续的安全手术服务。这项研究的结果将提供强有力的证据，为地方行为者在全国推广监督模式提供信息和指导。所吸取的经验教训将推广到更广泛的区域。
Background District-level hospitals (DLHs) can play an important role in the delivery of essential surgical services for rural populations in sub-Saharan Africa if adequately prepared and supported. This article describes the protocol for the evaluation of the Scaling up Safe Surgery for District and Rural Populations in Africa (SURG-Africa) project which aims to strengthen the capacity in district-level hospitals (DLHs) in Malawi, Tanzania and Zambia to deliver safe, quality surgery. The intervention comprises a programme of quarterly supervisory visits to surgically active district-level hospitals by specialists from referral hospitals and the establishment of a mobile phone-based consultation network. The overall objective is to test and refine the model with a view to scaling up to national level. Methods This mixed-methods controlled pilot trial will test the feasibility of the proposed supervision model in making quality-assured surgery available at DLHs. Firstly, the study will conduct a quantitative assessment of surgical service delivery at district facilities, looking at hospital preparedness, capacity and productivity, and how these are affected by the intervention. Secondly, the study will monitor changes in referral patterns from DLHs to a higher level of care as a result of the intervention. Data on utilisation of the mobile based-support network will also be collected. The analysis will compare changes over time and between intervention and control hospitals. The third element of the study will involve a qualitative assessment to obtain a better understanding of the functionality of DLH surgical systems and how these have been influenced by the intervention. It will also provide further information on feasibility, impact and sustainability of the supervision model. Discussion We seek to test a model of district-level capacity building through regular supervision by specialists and mobile phone technology-supported consultations to make safe surgical services more accessible, equitable and sustainable for rural populations in the target countries. The results of this study will provide robust evidence to inform and guide local actors in the national scale-up of the supervision model. Lessons learned will be transferred to the wider region.