Medical record bias in documentation of obstetric and neonatal clinical quality of care indicators in Uganda

Kim, Min kyung; Baumgartner, Joy Noel; Headley, Jennifer; Kirya, Julius; Kaggwa, James; Egger, Joseph

doi:10.1016/j.jclinepi.2021.02.024

Cited by 6 publications

(2 citation statements)

References 24 publications

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“…Whether the differences identified in adjusted coverage estimates are meaningful enough to increase the frequency of measurement depends on the acceptable degree of error (measurement as well as sampling) for a given application; they should certainly be considered when reporting any adjusted coverage analyses. Direct observation is a powerful method of assessing quality with clear benefits relative to routine indicators or record review [ 49 ], but its use for assessing sick child services requires further consideration to determine if this measure can provide reliable information within any timeframe with current sample sizes. Targeting direct observation appropriately and deploying it strategically would enhance the value of this approach.…”

Section: Discussionmentioning

confidence: 99%

Stability of healthcare quality measures for maternal and child services: Analysis of the continuous service provision assessment of health facilities in Senegal, 2012–2018

Leslie

Hategeka

Ndour

et al. 2021

Tropical Med Int Health

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Objective High‐quality healthcare is essential to ensuring maternal and newborn survival. Efficient measurement requires knowing how long measures of quality provide consistent insight for intended uses. Methods We used a repeated health facility assessment in Senegal to calculate structural and process quality of antenatal care (ANC), delivery and child health services in facilities assessed 2 years apart. We tested agreement of quality measures within facilities and regions. We estimated how much input‐adjusted and process quality‐adjusted coverage measures changed for each service when calculated using quality measurements from the same facilities measured 2 years apart. Results Over 6 waves of continuous surveys, 628 paired assessments were completed. Changes at the facility level were substantial and often positive, but inconsistent. Structural quality measures were moderately correlated (0.40–0.69) within facilities over time, more so in hospitals; correlation was <0.20 for process measures based on direct observation of ANC and child visits. Most measures were more strongly correlated once averaged to regions; process quality of child services was not (−0.32). Median relative difference in national‐adjusted coverage estimates was 6.0%; differences in subnational estimates were largest for process quality of child services (19.6%). Conclusion Continuous measures of structural quality demonstrated consistency at regional levels and in higher level facilities over 2 years; results for process measures were mixed. Direct observation of child visits provided inconsistent measures over time. For other measures, linking population data with health facility assessments from up to 2 years prior is likely to introduce modest measurement error in adjusted coverage estimates.

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Section: Discussionmentioning

confidence: 99%

Stability of healthcare quality measures for maternal and child services: Analysis of the continuous service provision assessment of health facilities in Senegal, 2012–2018

Leslie

Hategeka

Ndour

et al. 2021

Tropical Med Int Health

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“…Second, the quality of service in the SPA data set used for the current study was measured by direct observation, which is the most reliable method for assessing quality. Direct observation has been conclusively shown to be superior to routine indicators or record reviews [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Regional determinants of quality of care for sick children: A multilevel analysis in four countries

Lee,

Cooper,

Kruk

2024

J Glob Health

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Background The limited impact of increased access to care on improvements in health outcomes during the Millennium Development Goal era has been attributed, in part, to inadequate quality of care. We identified regional factors associated with health service quality for sick child care in low-income countries and examined whether provider factors interact with regional factors to affect the quality of care. Methods We conducted cross-sectional random intercept four-level linear regression using the most recent Service Provision Assessment and Demographic Health Survey data from four countries (467 from the Democratic Republic of Congo 2018, 2425 from Afghanistan 2018, 2072 from Nepal 2015, and 813 from Senegal 2017). The outcome variable was the service quality score for sick child care, which was measured as the percentage of clinically recommended tasks completed in the integrated management of childhood illness (ranging from 0 to 100). Regional factors were selected based on the High-Quality Health System Framework. Results The service quality score was found to be positively associated with the proportion of large facilities (β = 8.61; P = 0.004) and the proportion of providers ranked in the top fifth for service quality score (β = 30.15; P < 0.001) in the region. We identified significant cross-level interactions between provider qualifications (β = −16.6; P < 0.001) or job descriptions (β = 12.01; P = 0.002) and the proportion of providers in the top fifth for service quality scores within the region. As the proportion of top-performing providers in a region increased, the increase in the service quality score was more pronounced among providers who were nonmedical doctors or did not have job descriptions than among their counterparts. Conclusions Our findings indicate that the quality of care for sick children in a region improves with a greater proportion of high-performing providers or larger facilities. Providers who are not medical doctors, or those who have specific job descriptions, tend to benefit more from the presence of these top-performing providers.

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Timeliness of Delivery Care and Maternal and Neonatal Health Outcomes in Private Facilities in Masaka Area, Uganda: A Quasi-Experimental Study

Hagey

Kirya²,

Kaggwa³

et al. 2023

Matern Child Health J

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Medical record bias in documentation of obstetric and neonatal clinical quality of care indicators in Uganda

Cited by 6 publications

References 24 publications

Stability of healthcare quality measures for maternal and child services: Analysis of the continuous service provision assessment of health facilities in Senegal, 2012–2018

Stability of healthcare quality measures for maternal and child services: Analysis of the continuous service provision assessment of health facilities in Senegal, 2012–2018

Regional determinants of quality of care for sick children: A multilevel analysis in four countries

Timeliness of Delivery Care and Maternal and Neonatal Health Outcomes in Private Facilities in Masaka Area, Uganda: A Quasi-Experimental Study

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