Background To assess baseline quality of care in the Kyrgyz Republic in 2019 and determine the effect of online simulated patients in changing doctors’ practice in three specific disease areas: non-communicable disease, neonatal/child health, and maternal health. Methods Over 2000 family health, pediatric, neonatology, therapy, and obstetric-gynecologic doctors from every rayon (district) hospital and at least one associated family health (Primary) care clinic participated. To adequately scale the project, the Ministry of Health used online simulated Clinical Performance and Value (CPV) vignettes. All doctors cared for the same set of patients in their clinical area. Over eight months in 2019, we gathered three rounds of CPV data in seven oblasts. Results Overall quality scores were highly variable at baseline (59.2% + 13.5%). After three rounds the average score increased 6.5% ( P < 0.001). By the end of round three, the lowest scoring oblast was providing higher quality care compared to the highest scoring oblast in the initial round (64.2% in round 3 vs 62.4% in round 1), indicating greater adherence to the evidence base. Additionally, family health doctors ordered 26% fewer unnecessary tests ( P < 0.05), while specialists ordered 39% fewer unnecessary tests ( P < 0.05). If trends continue, this translates into a net annual savings of 63 million Kyrgyz som. Conclusions This study demonstrates serial measurement of care provided by over 2000 physicians in the Kyrgyz Republic can be improved as measured by CPVs. This project may be a useful template to improve health care quality at a national level in other low- and middle-income country settings.
Funding Acknowledgements Type of funding sources: None. Background Cardiovascular disease (CVD) is the leading cause of death in Central Asia. In 2019, crude mortality rate in the region was 348.13 per 100,000 population. Heart failure (HF) is important CVD subtype owing to even worse outcome. There has been a dearth of information on the epidemiology of HF in Central Asia. Purpose we aimed to describe aetiology, comorbidities, adherence to guideline-directed medical therapy (GDMT), and outcomes in patients hospitalised for heart failure in Central Asian population. Methods the retrospective analysis included 538 patients hospitalised for decompensated heart failure in a tertiary hospital from December 2011 to December 2019. Inclusion criteria were (i) age ≥18 years; (ii) hospitalisation for HF treatment. Exclusion criteria were (i) pregnancy; (ii) comorbidity with survival time considered to be <1 year on the basis of patients` medical history; (iii) acute HF caused by acute myocardial infarction, metabolic, toxic or infectious disorders. Primary outcome was one-year all-cause mortality, secondary outcome - readmission for HF at one year. Given that the data had been collected retrospectively, informed consent was not obtained, nevertheless, local ethics committee approved the study. Results Central Asian patients were relatively young (mean age 64.0 years), 61.2% of them were male, 77.7% had ischemic heart disease, 8.7% rheumatic heart disease, 32.2% obstructive pulmonary disease, 47.7% atrial fibrillation/flutter, 45.7% hyperlipidemia, 72.1% hypertension, and 31.6% diabetes mellitus. Use of GDMT at discharge was 76.0% for beta-blockers, 29.7% for angiotensin-converting enzyme inhibitors, 21.2% for angiotensin II receptor blockers, 71.9% for mineralocorticoid receptor antagonists. Only 3.9% of patients were implanted with a pacemaker and 0.9% with an implantable cardioverter defibrillator. All-cause mortality at one year was 19.0%, with no difference between patients with preserved and reduced ejection fraction (14.9 vs. 19.9%, p=0.243). However, patients with preserved ejection fraction were less likely to experience a readmission for heart failure at one year (13.9 vs. 29.3%, p=0.002). Conclusions results of the analysis showed that Central Asian patients are relatively young, mostly male, with high prevalence of ischemic heart disease, and reduced ejection fraction, and lower rate of GDMT use and device therapy.
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