142nd APHA Annual Meeting and Exposition

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309497
Quality Improvement (QI) through Small Tests of Change (STOC) to Improve Health Systems in Resource-Limited Settings

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Sunday, November 16, 2014

Samuel Muhula, Biostatistician , Monitoring and Evaluation Unit, AMREF Kenya, Nairobi, Kenya
Background: QI procedures have been proven to be highly effective in the poorest health systems, but often applied inappropriately. Objective: Demonstrate correct application of QI measures at ART programs in resource limited settings.  

Methodology: A descriptive before-and-after study with no control group is used to evaluate outcomes. October 2011-June 2012 and April–December 2013 were defined as pre and post -intervention stages respectively.  Time-series analysis was used to compare trends. Interventions involved training of Health Care Workers (HCWs) on CQI, establishment of CQI teams. Outcome measures included proportion of women screened for cervical cancer, lost to follow-up (LTFU) rates and linkage to care trends. The outcomes were achieved by employing several STOCs through Plan Do Study Act model.

Results: The program has 2,551 patients on ART. The median baseline CD4 count at start of ART was 349 cells/µl (IQR 201-497). Seventeen HCWs from 4 facilities were trained on CQI. Proportion of women screened for cervical cancer increased from 32% (95% CI, 16-48) to 77% (95% CI, 68-86); LTFUs rates reduced from 56% (95% CI, 43-69) to 24% (95% CI, 7-41); linkage to care improved from 58% (95% CI, 45-71) to 84% (95% CI, 76-92) and patient retention improved from 89% (95% CI, 83-96) to 94% (95% CI, 89-99) at pre and post-intervention periods respectively.

Conclusions: There is need to focus on building the capacity of HCWs to deliver quality services at primary health care facilities through promotion of data use for decision making, building QI teams, and carrying out STOCs

Learning Areas:

Provision of health care to the public

Learning Objectives:
Demonstrate correct application of QI measures at ART programs in resource limited settings

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Continuous Quality Improvement (CQI) lead at AMREF Kenya and supports implementation of the same in more than 47 projects funded by various donors. Am therefore interested in documentation of CQI outcomes and scaling up strategies proven to be replicable
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.