247445 Quality Improvement in a Tuberculosis Clinic in Chimbote, Peru

Tuesday, November 1, 2011: 8:48 AM

Ana Maria Morales, MD , Infectious Diseases Specialist, Quality Healthcare Project, San Borja, Peru
Armida Montanez, RN , TB Prevention and Control Program, South Pacific Health Network, Chimbote, Ancash, Peru
Guillermo Frias, MD, MPH , Regional Operations Manager, Quality Healthcare Project, Lima, Peru
Tony Suarez, RN , TB Prevention and Control Program, Yugoslavia Health Center, Chimbote, Ancash, Peru
Leonarda Quispe, RN , TB Prevention and Control Program, Ancash Regional Health Directorate, Huaraz, Ancash, Peru
A comprehensive approach was implemented at the Yugoslavia Health Center (HC) aimed to improve quality of provision of tuberculosis (TB) services. This HCxs TB clinic was severely understaffed and disorganized, resulting in a low rate of identification of persons with respiratory symptoms and a high defaulter to treatment rate. Methods: After minor infrastructure improvements and assignment of additional staff to the TB clinic, the Standard-Based Management and Recognition (SBM-R) methodology was implemented to identify performance gaps and elaborate local improvement plans. These plans were designed to: (i) increase identification of persons with respiratory symptoms by educating communities through skits performed by HC staff; and (ii) reduce the defaulter to treatment rate by training peer educators and strengthening home visit programs. Methods for recognizing achievements will be determined and implemented in the near future. Results: Performance of the TB clinics was improved, lowering the performance gaps from 73% (June 2010) to 48% (January 2011). Simultaneously, identification of persons with respiratory symptoms rapidly increased from 2.2% to 4.76% in July and 5.05% in December 2010. The defaulters to treatment rate decreased from 18% during 2009 to 0 % during 2010. Conclusions: Performance improvement of a TB clinic could be rapidly achieved by a comprehensive approach, including infrastructure improvement, adequate staffing and use of the SBM-R.

Learning Areas:
Program planning
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Explain the comprehensive approach used to improve performance of a TB primary care facility. Describe this approach's impact on operational indicators of the TB control program. Discuss how a quality improvement approach might be used in TB clinics in other countries.

Keywords: Tuberculosis, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am working as member of the project technical team who supports the experience of TB quality improvement in Chimbote, Peru
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.