Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia
Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia
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DOI：
10.1186/1478-4491-12-73
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发表时间：
2014-12-20
影响因子：
4.5
通讯作者：
Kim, Young Mi
中科院分区：
文献类型：
--
作者：
Bazant, Eva;Sarkar, Supriya;Kim, Young Mi
背景：人力资源短缺和艾滋病毒相关护理的改革使南部非洲的一线医疗保健提供者难以提供高质量的服务。在赞比亚国防军的卫生设施中，实施了绩效和质量改进方法，以改善与艾滋病毒相关的护理，并于 2010/2011 年进行了评估。对提供者工作环境的变化和艾滋病毒相关护理的感知质量进行了评估，以补充提供者绩效的数据。方法：干预措施包括现场培训、支持性监督和侧重于详细服务提供标准的行动计划。准实验评估从八个与国防军分支和基线客户量相匹配的干预和比较设施中收集了干预前和干预后的数据。总体而言，101 家提供者回答了一份包含 24 项工作环境的调查问卷，涵盖药品、用品和设备等主题；培训、反馈和监督；赔偿;人员配备；安全;履行;和艾滋病毒服务质量。在双变量分析和多变量分析中，我们评估了每个研究组内部以及两组之间的变化。结果：在双变量分析中，干预组提供者报告工作环境在设备充足性、免受伤害的安全感、对临床技能的信心和隔离减少方面有所改善，而对照组报告在供应、培训、安全和部门士气方面工作环境恶化。在多变量分析中，干预组在药物、用品和设备的充足性感知上有显着的改善，而对照组的下降则显着；从主管和同事那里收到的建设性反馈；感觉安全，免受身体伤害（所有 P < 0.01，设备 P < 0.04 除外）。此外，“提供者对某些临床技能缺乏信心”这一项目在干预组中下降，但在对照组中上升（P = -0.005）。在多变量分析中，研究组之间对艾滋病毒护理感知质量的变化没有差异。提供者的看法与准备药物、用品、设备以及预防艾滋病毒母婴传播和抗逆转录病毒治疗后续护理提供服务的观察结果一致。结论：在赞比亚国防军卫生设施实施的绩效和质量改进干预措施与提供者对工作环境的看法改善有关，这与干预措施的重点是商品、技能获取和接收建设性反馈相一致。
Background: Human resource shortages and reforms in HIV-related care make it challenging for frontline health care providers in southern Africa to deliver high-quality services. At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers' work environment and perceived quality of HIV-related care were assessed to complement data of provider performance.Methods: The intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. Overall, 101 providers responded to a 24-item questionnaire on the work environment, covering topics of drugs, supplies, and equipment; training, feedback, and supervision; compensation; staffing; safety; fulfilment; and HIV services quality. In bivariate analysis and multivariate analyses, we assessed changes within each study group and between the two groups.Results: In the bivariate analysis, the intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale. In the multivariate analysis, the intervention group's improvement and the comparison group's decline were significant on perceived adequacy of drugs, supplies, and equipment; constructive feedback received from supervisor and co-workers; and feeling safe from physical harm (all P < 0.01, except P < 0.04 for equipment). Further, the item "provider lacks confidence in some clinical skills" declined in the intervention group but increased in the comparison group (P = -0.005). In multivariate analysis, changes in perceived quality of HIV care did not differ between study groups. Provider perceptions were congruent with observations of preparing drugs, supplies, equipment, and in service delivery of prevention of mother-to-child transmission of HIV and antiretroviral therapy follow-up care.Conclusions: The performance and quality improvement intervention implemented at Zambian Defence Forces' health facilities was associated with improvements in providers' perceptions of work environment consistent with the intervention's focus on commodities, skills acquisition, and receipt of constructive feedback.