Ontology highlight
ABSTRACT: Objective
To test the success of a maternal healthcare quality improvement intervention in actually improving quality.Design
Cluster-randomized controlled study with implementation evaluation; we randomized 12 primary care facilities to receive a quality improvement intervention, while 12 facilities served as controls.Setting
Four districts in rural Tanzania.Participants
Health facilities (24), providers (70 at baseline; 119 at endline) and patients (784 at baseline; 886 at endline).Interventions
In-service training, mentorship and supportive supervision and infrastructure support.Main outcome measures
We measured fidelity with indictors of quality and compared quality between intervention and control facilities using difference-in-differences analysis.Results
Quality of care was low at baseline: the average provider knowledge test score was 46.1% (range: 0-75%) and only 47.9% of women were very satisfied with delivery care. The intervention was associated with an increase in newborn counseling (?: 0.74, 95% CI: 0.13, 1.35) but no evidence of change across 17 additional indicators of quality. On average, facilities reached 39% implementation. Comparing facilities with the highest implementation of the intervention to control facilities again showed improvement on only one of the 18 quality indicators.Conclusions
A multi-faceted quality improvement intervention resulted in no meaningful improvement in quality. Evidence suggests this is due to both failure to sustain a high-level of implementation and failure in theory: quality improvement interventions targeted at the clinic-level in primary care clinics with weak starting quality, including poor infrastructure and low provider competence, may not be effective.
SUBMITTER: Larson E
PROVIDER: S-EPMC7172021 | biostudies-literature | 2020 Apr
REPOSITORIES: biostudies-literature
Larson Elysia E Mbaruku Godfrey M GM Cohen Jessica J Kruk Margaret E ME
International journal for quality in health care : journal of the International Society for Quality in Health Care 20200401 1
<h4>Objective</h4>To test the success of a maternal healthcare quality improvement intervention in actually improving quality.<h4>Design</h4>Cluster-randomized controlled study with implementation evaluation; we randomized 12 primary care facilities to receive a quality improvement intervention, while 12 facilities served as controls.<h4>Setting</h4>Four districts in rural Tanzania.<h4>Participants</h4>Health facilities (24), providers (70 at baseline; 119 at endline) and patients (784 at baseli ...[more]