Quality of care and health status in Ukraine

BACKGROUND: We conducted a national level assessment of the quality of clinical care practice in the Ukrainian healthcare system for two important causes of death and chronic disease conditions. We tested two hypotheses: a) quality of care is predicted by physician and facility characteristics and b) health status is predicted by quality of care. METHODS: During 2009–2010 in Ukraine, we collected nationally-representative data from clinical facilities, physicians, Clinical Performance and Value (CPV®) vignettes, patient surveys from the facilities, and from the general population. Each physician completed a written CPV® vignette—a simulated case scenario of a typical patient visit—for each of two clinical cases, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD). CPV® vignette scores, calculated as a percentage of all care criteria completed by the physician, were used as the measure of clinical quality of care. Self-reported health measures were collected from exit and household survey respondents. Regression models were developed to test the two study hypotheses. RESULTS: 136 hospitals and 125 polyclinics were surveyed; 1,044 physicians were interviewed and completed CPV® vignettes. On average physicians scored 47.4% on the vignettes. Younger, female physicians provide a higher quality of care—as well as those that have had recent continuing medical education (CME) in chronic disease or health behaviors. Higher quality was associated with better health outcomes. CONCLUSIONS: As low- and middle-income countries around the world are challenged by non-communicable diseases, higher quality of care provided to these populations may result in better outcomes, such as improved health status and life expectancy, and overcome regional shortfalls. Policy efforts that serially evaluate quality may improve chronic disease care.