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Implementation of an individual patient prospective database of hospital births in Sri Lanka and its use for improving quality of care.

ABSTRACT: OBJECTIVES:This study was aimed at piloting a prospective individual patient database on hospital deliveries in Colombo, Sri Lanka, and at exploring its use for developing recommendations for improving quality of care (QoC). DESIGN:Observational study. SETTING:De Soysa Maternity Hospital, the largest referral hospital for maternity care in Sri Lanka. DATA COLLECTION AND ANALYSIS:From July 2015 to June 2017, 150 variables were collected for each delivery using a standardised form and entered into a database. Data were analysed every 8?months, and the results made available to local staff. Outcomes of the study included: technical problems; data completeness; data accuracy; key database findings; and use of data. RESULTS:7504 deliveries were recorded. No technical problem was reported. Data completeness exceeded that of other existing hospital recording systems. Less than 1% data were missing for maternal variables and less than 3% for newborn variables. Mistakes in data collection and entry occurred in 0.01% and 0.09% of maternal and newborn data, respectively. Key QoC indicators identified in comparison with international standards were: relatively low maternal mortality (0.053%); relatively high maternal near-miss cases (3.4%); high rate of induction of labour (24.6%), caesarean section (30.0%) and episiotomy (56.1%); relatively high rate of preterm births (9.4%); low birthweight rate (16.5%); stillbirth (0.97%); and of total deaths in newborn (1.98%). Based on key indicators identified, a list of recommendations was developed, including the use checklists to standardise case management, training, clinical audits and more information for patients. A list of lessons learnt with the implementation of the data collection system was also drawn. CONCLUSIONS:The study shows that the implemented system of data collection can produce a large quantity of reliable information. Most importantly, this experience provides an example on how database findings can be used for discussing hospital practices, identifying gaps and to agree on recommendations for improving QoC.

SUBMITTER: Lazzerini M

PROVIDER: S-EPMC6368149 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Implementation of an individual patient prospective database of hospital births in Sri Lanka and its use for improving quality of care.

Lazzerini Marzia M Senanayake Hematha H Mohamed Rishard R Kaluarachchi Athula A Fernando Roshini R Sakalasuriya Anshumalie A Ihsan Fathima Reshma FR Saravanabhava Namasivayam N Gamaathige Nalin N Jayawardane Madura M Gamage Ruwan Vidana RV Covi Benedetta B Wanzira Humphrey H Businelli Caterina C Piccoli Monica M

BMJ open 20190219 2

<h4>Objectives</h4>This study was aimed at piloting a prospective individual patient database on hospital deliveries in Colombo, Sri Lanka, and at exploring its use for developing recommendations for improving quality of care (QoC).<h4>Design</h4>Observational study.<h4>Setting</h4>De Soysa Maternity Hospital, the largest referral hospital for maternity care in Sri Lanka.<h4>Data collection and analysis</h4>From July 2015 to June 2017, 150 variables were collected for each delivery using a stand ...[more]

PMID: 30782885

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Project description:ObjectivesThis study aimed at describing the use of a prospective database on hospital deliveries for analysing caesarean section (CS) practices according to the WHO manual for Robson classification, and for developing recommendations for improving the quality of care (QoC).DesignObservational study.SettingUniversity Obstetric Unit at De Soysa Hospital for Women, the largest maternity unit in Sri Lanka.Data collection and analysisFor each childbirth, 150 variables were routinely collected in a standardised form and entered into a database. Data were routinely monitored for ensuring quality. Information on deliveries occurring from July 2015 to June 2017 were analysed according the WHO Robson classification manual. Findings were discussed internally to develop quality improvement recommendations.Results7504 women delivered in the hospital during the study period and at least one maternal or fetal pathological condition was reported in 2845 (37.9%). The CS rate was 30.0%, with 11.9% CS being performed prelabour. According to the Robson classification, Group 3 and Group 1 were the most represented groups (27.0% and 23.1% of population, respectively). The major contributors to the CS rate were group 5 (29.6%), group 1 (14.0%), group 2a (13.3%) and group 10 (11.5%). The most commonly reported indications for CS included abnormal cardiotocography/suspected fetal distress, past CS and failed progress of labour or failed induction. These suggested the need for further discussion on CS practices. Overall, 18 recommendations were agreed on. Besides updating protocols and hands-on training, activities agreed on included monitoring and supervision, criterion-based audits, risk management meetings and appropriate information for patients, and recommendations to further improve the quality of data.ConclusionsThis study provides an example on how the WHO manual for Robson classification can be used in an action-oriented manner for developing recommendations for improving the QoC, and the quality of data collected.

Project description:Soil data for Sri Lanka are available through semi-detailed series maps that were developed based on limited soil profile data combined with expert knowledge. This data plays a vital role in decisions at national and regional levels. However, the present format of this database does not allow for their wider use in crop simulation modelling and other related agricultural research that require finer scale data. This is due to the fact that cross-country profile data are not harmonised based on standard depths. Several attempts were made to produce digital soil data for Sri Lanka at different geographic scales, however, a completely harmonised data that covers variability across depths and properties is yet to be made available. In this article, we describe the first version of the open digital soil database that was developed using a database of 122 locations across the country. Soil properties were harmonised for standard depths using equal-area quadratic smoothing splines. Out of several interpolation methods that were evaluated for univariate interpolation, maps which were produced with the least overall error (RMSE) in the process of cross-validation were selected. The newly developed digital soil database contains 9 soil properties; pH, bulk density, cation exchange capacity, organic carbon, volumetric moisture content at 0.33 and 15 bars levels, sand silt and clay content. Moreover, the data are available for five standard depth layers as 0-5, 5-15, 15-30, 30-60 and 60-100 cm in raster format at 1 km spatial resolution. Both interpolated property maps and their error maps were stored in an open repository and made available for public use. The first version of all maps is also showcased online through open web mapping services. The repository will be gradually updated with higher resolution and more accurate maps as more samples become available and better interpolation method are used. This data could provide complementary information for insight generation at finer scales where limited local informaiton about soils hinders agricultural development.

Project description:Background and objectivesA kidney disease of unknown cause is common in Sri Lanka's lowland (dry) region. Detailed clinical characterizations of patients with biopsy-proven disease are limited, and there is no current consensus on criteria for a noninvasive diagnosis.Design, setting, participants, & measurementsWe designed a prospective study in a major Sri Lankan hospital servicing endemic areas to ascertain pathologic and clinical characteristics of and assess risk factors for primary tubulointerstitial kidney disease. We used logistic regression to determine whether common clinical characteristics could be used to predict the presence of primary tubulointerstitial kidney disease on kidney biopsy.ResultsFrom 600 new patients presenting to a tertiary nephrology clinic over the course of 1 year, 87 underwent kidney biopsy, and 43 (49%) had a biopsy diagnosis of primary tubulointerstitial kidney disease. On detailed biopsy review, 13 (30%) had evidence of moderate to severe active kidney disease, and six (15%) had evidence of moderate to severe chronic tubulointerstitial kidney disease. Patients with tubulointerstitial kidney disease were exclusively born in endemic provinces; 91% spent a majority of their lifespan there. They were more likely men and farmers (risk ratio, 2.0; 95% confidence interval, 1.2 to 2.9), and they were more likely to have used tobacco (risk ratio, 1.7; 95% confidence interval, 1.0 to 2.3) and well water (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). Three clinical characteristics-age, urine dipstick for protein, and serum albumin-could predict likelihood of tubulointerstitial kidney disease on biopsy (model sensitivity of 79% and specificity of 84%). Patients referred for kidney biopsy despite comorbid diabetes or hypertension did not experience lower odds of tubulointerstitial kidney disease.ConclusionsA primary tubulointerstitial kidney disease occurs commonly in specific regions of Sri Lanka with characteristic environmental and lifestyle exposures.

Project description:Sri Lanka records substantial numbers of snakebite annually. Primary rural hospitals are important contributors to health care. Health care planning requires a more detailed understanding of snakebite within this part of the health system. This study reports the management and epidemiology of all hospitalised snakebite in the Kurunegala district in Sri Lanka.The district has 44 peripheral/primary hospitals and a tertiary care hospital-Teaching Hospital, Kurunegala (THK). This prospective study was conducted over one year. All hospitals received copies of the current national guidelines on snakebite management. Clinical and demographic details of all snakebite admissions to primary hospitals were recorded by field researchers and validated by comparing with scanned copies of the medical record. Management including hospital transfers was independently assessed against the national guidelines recommendation. Population rates were calculated and compared with estimates derived from recent community based surveys.There were 2186 admissions of snakebites and no deaths in primary hospitals. An additional 401 patients from the district were admitted directly to the teaching hospital, 2 deaths were recorded in this group. The population incidence of hospitalized snakebite was 158/100,000 which was significantly lower than community survey estimates of 499/100,000. However there was no significant difference between the incidence of envenomation of 126/100,000 in hospitalised patients and 184/100,000 in the community survey. The utilisation of antivenom was appropriate and consistent with guidelines. Seventy patients received antivenom. Anaphylactic reactions to antivenom occurred in 22 patients, treatment reactions was considered to be outside the guidelines in 5 patients. Transfers from the primary hospital occurred in 399(18%) patients but the majority (341) did not meet the guideline criteria. A snake was identified in 978 cases; venomous snakebites included 823 hump-nosed viper (Hypnalespp), 61 Russell's viper, 14 cobra, 13 common krait, 03 saw scaled viper.Primary hospitals received a significant number of snakebites that would be missed in surveys conducted in tertiary hospitals. Adherence to guidelines was good for the use of antivenom but not for hospital transfer or treatment of anaphylaxis. The large difference in snakebite incidence between community and hospital studies could possibly be due to non-envenomed patients not presenting. As the majority of snakebite management occurs in primary hospitals education and clinical support should be focused on that part of the health system.

Project description:IntroductionThe cost in managing hospitalised dengue patients varies across countries depending on access to healthcare, management guidelines, and state sponsored subsidies. For health budget planning, locally relevant, accurate costing data from prospective studies, is essential.ObjectiveTo characterise the direct costs of managing hospitalised patients with suspected dengue infection in Sri Lanka.MethodsColombo Dengue Study is a prospective single centre cohort study in Sri Lanka recruiting suspected hospitalised dengue fever patients in the first three days of fever and following them up until discharge. The diagnosis of dengue is retrospectively confirmed and the cohort therefore has a group of non-dengue fever patients with a phenotypically similar illness, managed as dengue while in hospital. The direct costs of hospital admission (base and investigation costs, excluding medication) were calculated for all recruited patients and compared between dengue and non-dengue categories as well as across subgroups (demographic, clinical or temporal) within each of these categories. We also explored if excluding dengue upfront, would lead to an overall cost saving in several hypothetical scenarios.ResultsFrom October 2017 to February 2020, 431 adult dengue patients and 256 non-dengue fever patients were recruited. The hospitalisation costs were USD 18.02 (SD: 4.42) and USD 17.55 (SD: 4.09) per patient per day for dengue and non-dengue patients respectively (p>0.05). Laboratory investigations (haematological, biochemical and imaging) accounted for more than 50% of the total cost. The costs were largely homogenous in all subgroups within or across dengue and non-dengue categories. Excluding dengue upfront by subsidised viral genomic testing may yield overall cost savings for non-dengue patients.ConclusionAs non-dengue patients incur a similar cost per day as the dengue patients, confirming dengue diagnosis using subsidised tests for patients presenting in the first three days of fever may be cost-efficient.

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Implementation of an individual patient prospective database of hospital births in Sri Lanka and its use for improving quality of care.

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Implementation of an individual patient prospective database of hospital births in Sri Lanka and its use for improving quality of care.

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