Improving documentation of clinical care within a clinical information network: an essential initial step in efforts to understand and improve care in Kenyan hospitals

Abstract

In many low income countries health information systems are poorly equipped to provide detailed information on hospital care and outcomes. Information is thus rarely used to support practice improvement. We describe efforts to tackle this challenge and to foster learning concerning collection and use of information. This could improve hospital services in Kenya.We are developing a Clinical Information Network, a collaboration spanning 14 hospitals, policy makers and researchers with the goal of improving information available on the quality of inpatient paediatric care across common childhood illnesses in Kenya. Standardised data from hospitals’ paediatric wards are collected using non-commercial and open source tools. We have implemented procedures for promoting data quality which are performed prior to a process of semi-automated analysis and routine report generation for hospitals in the network.In the first phase of the Clinical Information Network, we collected data on over 65 000 admission episodes. Despite clinicians’ initial unfamiliarity with routine performance reporting, we found that, as an initial focus, both engaging with each hospital and providing them information helped improve the quality of data and therefore reports. The process has involved mutual learning and building of trust in the data and should provide the basis for collaborative efforts to improve care, to understand patient outcome, and to evaluate interventions through shared learning.We have found that hospitals are willing to support the development of a clinically focused but geographically dispersed Clinical Information Network in a low-income setting. Such networks show considerable promise as platforms for collaborative efforts to improve care, to provide better information for decision making, and to enable locally relevant research.

Magnitude and pattern of improvement in processes of care for hospitalised children with diarrhoea and dehydration in Kenyan hospitals participating in a clinical network

“…Our analysis of data from 13 hospitals involved in collaborative efforts aimed at promoting guideline adherence across a range of common childhood illnesses in Kenyan hospitals shows that documentation for various processes of care improved . Using a recently developed composite score for processes of admission care, the PAQC score , we show that the process of DD admission care as a whole improved over time.…”

Purposeful Design of a Survey Tool to Evaluate the Adequacy of Hospitals’ Water Sanitation and Hygiene and Allocate Responsibility for Action – from Wash FIT to Wash Fast

“…The county hospitals vary in size and are from 11 counties in both high and low malaria zones in Kenya (5 and 9 sites respectively). Hospitals were purposefully selected based on links developed from ongoing work to improve clinical information as part of a collaboration between the KEMRI-Wellcome Trust Research Programme and the Ministry of Health (MOH) (12).…”

Hospital Mortality – a neglected but rich source of information supporting the transition to higher quality health systems in low and middle income countries

“…The possible use of hospital mortality data from specific populations as one indicator of the quality of hospital care in LMIC would however, depend on the availability of high quality individual level data from facilities with at least moderately high inpatient workloads (see Box 2). At least in one clinical arena recent research suggests obtaining better quality routine data on individual cases might be possible if simple standardised record forms are introduced [55] and could be facilitated by emerging efforts to implement electronic medical records at scale [56]. In Fig.…”