Cargando…
Assessment of paediatric inpatient care during a multifaceted quality improvement intervention in Kenyan District Hospitals – use of prospectively collected case record data
BACKGROUND: In assessing quality of care in developing countries, retrospectively collected data are usually used given their availability. Retrospective data however suffer from such biases as recall bias and non-response bias. Comparing results obtained using prospectively and retrospectively coll...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110369/ https://www.ncbi.nlm.nih.gov/pubmed/25035114 http://dx.doi.org/10.1186/1472-6963-14-312 |
_version_ | 1782327989093007360 |
---|---|
author | Mwaniki, Paul Ayieko, Philip Todd, Jim English, Mike |
author_facet | Mwaniki, Paul Ayieko, Philip Todd, Jim English, Mike |
author_sort | Mwaniki, Paul |
collection | PubMed |
description | BACKGROUND: In assessing quality of care in developing countries, retrospectively collected data are usually used given their availability. Retrospective data however suffer from such biases as recall bias and non-response bias. Comparing results obtained using prospectively and retrospectively collected data will help validate the use of the easily available retrospective data in assessing quality of care in past and future studies. METHODS: Prospective and retrospective datasets were obtained from a cluster randomized trial of a multifaceted intervention aimed at improving paediatric inpatient care conducted in eight rural Kenyan district hospitals by improving management of children admitted with pneumonia, malaria and diarrhea and/or dehydration. Four hospitals received a full intervention and four a partial intervention. Data were collected through 3 two weeks surveys conducted at baseline, after 6 and 18 months. Retrospective data was sampled from paediatric medical records of patients discharged in the preceding six months of the survey while prospective data was collected from patients discharged during the two week period of each survey. Risk Differences during post-intervention period of16 quality of care indicators were analyzed separately for prospective and retrospective datasets and later plotted side by side for comparison. RESULTS: For the prospective data there was strong evidence of an intervention effect for 8 of the indicators and weaker evidence of an effect for one indicator, with magnitude of effect sizes varying from 23% to 60% difference. For the retrospective data, 10 process (these include the 8 indicators found to be statistically significant in prospective data analysis) indicators had statistically significant differences with magnitude of effects varying from 10% to 42%. The bar-graph comparing results from the prospective and retrospective datasets showed similarity in terms of magnitude of effects and statistical significance for all except two indicators. CONCLUSION: Multifaceted interventions can help improve adoption of clinical guidelines and hence improve the quality of care. The similar inference reached after analyses based on prospective assessment of case management is a useful finding as it supports the utility of work based on examination of retrospectively assembled case records allowing longer time periods to be studied while constraining costs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN42996612. Trial registration date: 20/11/2008 |
format | Online Article Text |
id | pubmed-4110369 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-41103692014-07-26 Assessment of paediatric inpatient care during a multifaceted quality improvement intervention in Kenyan District Hospitals – use of prospectively collected case record data Mwaniki, Paul Ayieko, Philip Todd, Jim English, Mike BMC Health Serv Res Research Article BACKGROUND: In assessing quality of care in developing countries, retrospectively collected data are usually used given their availability. Retrospective data however suffer from such biases as recall bias and non-response bias. Comparing results obtained using prospectively and retrospectively collected data will help validate the use of the easily available retrospective data in assessing quality of care in past and future studies. METHODS: Prospective and retrospective datasets were obtained from a cluster randomized trial of a multifaceted intervention aimed at improving paediatric inpatient care conducted in eight rural Kenyan district hospitals by improving management of children admitted with pneumonia, malaria and diarrhea and/or dehydration. Four hospitals received a full intervention and four a partial intervention. Data were collected through 3 two weeks surveys conducted at baseline, after 6 and 18 months. Retrospective data was sampled from paediatric medical records of patients discharged in the preceding six months of the survey while prospective data was collected from patients discharged during the two week period of each survey. Risk Differences during post-intervention period of16 quality of care indicators were analyzed separately for prospective and retrospective datasets and later plotted side by side for comparison. RESULTS: For the prospective data there was strong evidence of an intervention effect for 8 of the indicators and weaker evidence of an effect for one indicator, with magnitude of effect sizes varying from 23% to 60% difference. For the retrospective data, 10 process (these include the 8 indicators found to be statistically significant in prospective data analysis) indicators had statistically significant differences with magnitude of effects varying from 10% to 42%. The bar-graph comparing results from the prospective and retrospective datasets showed similarity in terms of magnitude of effects and statistical significance for all except two indicators. CONCLUSION: Multifaceted interventions can help improve adoption of clinical guidelines and hence improve the quality of care. The similar inference reached after analyses based on prospective assessment of case management is a useful finding as it supports the utility of work based on examination of retrospectively assembled case records allowing longer time periods to be studied while constraining costs. TRIAL REGISTRATION: Current Controlled Trials ISRCTN42996612. Trial registration date: 20/11/2008 BioMed Central 2014-07-18 /pmc/articles/PMC4110369/ /pubmed/25035114 http://dx.doi.org/10.1186/1472-6963-14-312 Text en Copyright © 2014 Mwaniki et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Mwaniki, Paul Ayieko, Philip Todd, Jim English, Mike Assessment of paediatric inpatient care during a multifaceted quality improvement intervention in Kenyan District Hospitals – use of prospectively collected case record data |
title | Assessment of paediatric inpatient care during a multifaceted quality improvement intervention in Kenyan District Hospitals – use of prospectively collected case record data |
title_full | Assessment of paediatric inpatient care during a multifaceted quality improvement intervention in Kenyan District Hospitals – use of prospectively collected case record data |
title_fullStr | Assessment of paediatric inpatient care during a multifaceted quality improvement intervention in Kenyan District Hospitals – use of prospectively collected case record data |
title_full_unstemmed | Assessment of paediatric inpatient care during a multifaceted quality improvement intervention in Kenyan District Hospitals – use of prospectively collected case record data |
title_short | Assessment of paediatric inpatient care during a multifaceted quality improvement intervention in Kenyan District Hospitals – use of prospectively collected case record data |
title_sort | assessment of paediatric inpatient care during a multifaceted quality improvement intervention in kenyan district hospitals – use of prospectively collected case record data |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110369/ https://www.ncbi.nlm.nih.gov/pubmed/25035114 http://dx.doi.org/10.1186/1472-6963-14-312 |
work_keys_str_mv | AT mwanikipaul assessmentofpaediatricinpatientcareduringamultifacetedqualityimprovementinterventioninkenyandistricthospitalsuseofprospectivelycollectedcaserecorddata AT ayiekophilip assessmentofpaediatricinpatientcareduringamultifacetedqualityimprovementinterventioninkenyandistricthospitalsuseofprospectivelycollectedcaserecorddata AT toddjim assessmentofpaediatricinpatientcareduringamultifacetedqualityimprovementinterventioninkenyandistricthospitalsuseofprospectivelycollectedcaserecorddata AT englishmike assessmentofpaediatricinpatientcareduringamultifacetedqualityimprovementinterventioninkenyandistricthospitalsuseofprospectivelycollectedcaserecorddata |