Survey using incognito standardized patients shows poor quality care in China’s rural clinics

Sylvia, Sean; Shi, Yaojiang; Xue, Hao; Tian, Xiujuan; Wang, Huan; Liu, Qingmei; Medina, Alexis; Rozelle, Scott

doi:10.1093/heapol/czu014

Cited by 139 publications

(153 citation statements)

References 31 publications

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“…4, 6, 11–14 Consequently, standardized patients (SPs) are increasingly used in low-income countries to assess quality of medical care, as shown by recent studies from India and China. 5136 Relative to other methods, data from SPs yield an assessment of provider practice that is free from observation bias, less vulnerable to recall bias than patient exit interviews, and more complete than medical records. 14, 15 Further, SPs permit estimates of case detection rates since illnesses are fixed by design.…”

Section: Introductionmentioning

confidence: 99%

Use of standardised patients to assess quality of tuberculosis care: a pilot, cross-sectional study

Das

Kwan

Daniels

et al. 2015

The Lancet Infectious Diseases

212

259

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SUMMARY Background Existing studies on quality of tuberculosis care mostly reflect knowledge, not actual practice. Methods We conducted a validation study on the use of standardized patients (SPs) for assessing quality of TB care. Four cases, two for presumed TB and one each for confirmed TB and suspected MDR-TB, were presented by 17 SPs, with 250 SP interactions among 100 consenting providers in Delhi, including qualified (29%), alternative medicine (40%) and informal providers (31%). Validation criteria were: (1) negligible risk and ability to avoid adverse events for providers and SPs; (2) low detection rates of SPs by providers, and (3) data accuracy across SPs and audio verification of SP recall. We used medical vignettes to assess provider knowledge for presumed TB. Correct case management was benchmarked using Standards for TB Care in India (STCI). Findings SPs were deployed with low detection rates (4.7% of 232 interactions), high correlation of recall with audio recordings (r=0.63; 95% CI: 0.53 – 0.79), and no safety concerns. Average consultation length was 6 minutes with 6.2 questions/exams completed, representing 35% (95% confidence interval [CI]: 33%–38%) of essential checklist items. Across all cases, only 52 of 250 (21%; 95% CI: 16%–26%) were correctly managed. Correct management was higher among MBBS doctors (adjusted OR=2.41, 95% CI: 1.17–4.93) as compared to all others. Provider knowledge in the vignettes was markedly more consistent with STCI than their practice. Interpretation The SP methodology can be successfully implemented to assess TB care. Our data suggest a big gap between provider knowledge and practice.

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Section: Introductionmentioning

confidence: 99%

Use of standardised patients to assess quality of tuberculosis care: a pilot, cross-sectional study

Das

Kwan

Daniels

et al. 2015

The Lancet Infectious Diseases

212

259

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“…Sylvia et al 6 report correct case management rates of 52–53% among village clinicians in rural China for chest pain and child diarrhoea, and Mohanan et al 7 report that rates of Oral Rehydration Salts were only 3.5% for child diarrhoea in Bihar. Similarly, low rates are also reported for other tracer conditions: for tuberculosis, correct case management rates were 21% for a sample of providers from Delhi, India 8.…”

Section: Introductionmentioning

confidence: 99%

Enhancing quality of medical care in low income and middle income countries through simulation-based initiatives: recommendations of the Simnovate Global Health Domain Group

Puri¹,

Das²,

Pai³

et al. 2017

BMJ STEL

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BackgroundQuality of medical care in low income and middle income countries (LMICs) is variable, resulting in significant medical errors and adverse patient outcomes. Integration of simulation-based training and assessment may be considered to enhance quality of patient care in LMICs. The aim of this study was to consider the role of simulation in LMICs, to directly impact health professions education, measurement and assessment.MethodsThe Simnovate Global Health Domain Group undertook three teleconferences and a direct face-to-face meeting. A scoping review of published studies using simulation in LMICs was performed and, in addition, a detailed survey was sent to the World Directory of Medical Schools and selected known simulation centres in LMICs.ResultsStudies in LMICs employed low-tech manikins, standardised patients and procedural simulation methods. Low-technology manikins were the majority simulation method used in medical education (42%), and focused on knowledge and skills outcomes. Compared to HICs, the majority of studies evaluated baseline adherence to guidelines rather than focusing on improving medical knowledge through educational intervention. There were 46 respondents from the survey, representing 21 countries and 28 simulation centres. Within the 28 simulation centres, teachers and trainees were from across all healthcare professions.DiscussionBroad use of simulation is low in LMICs, and the full potential of simulation-based interventions for improved quality of care has yet to be realised. The use of simulation in LMICs could be a potentially untapped area that, if increased and/or improved, could positively impact patient safety and the quality of care.

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“…We used a proxy, standardized patient, case method, 8 in which a father seeks treatment for his 2-year-old son who has the same clinical symptoms described in the vignettes. The cases and methods used for standardized patients were developed by members of our study team and have now been used in numerous settings 8 , 31 , 32 . Knowledge and performance scores were calculated for the vignettes and standardized patients, respectively, according to item response theory and based on whether the correct diagnostic questions had been asked and the appropriate examinations had been proposed 23 , 33 …”

Section: Methodsmentioning

confidence: 99%

Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India

Mohanan

Giardili

Das

et al. 2017

Bull. World Health Organ.

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ObjectiveTo evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme – the World Health Partners’ Sky Program.MethodsWe investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Providers were assessed using hypothetical patient vignettes and the standardized patient method both before and after programme implementation, in 2011 and 2014, respectively. Differences in providers’ performance between implementation and nonimplementation areas were assessed using multivariate difference-in-difference linear regression models.FindingsThe programme did not significantly improve health-care providers’ knowledge or performance with regard to childhood diarrhoea or pneumonia in Bihar. There was a persistent large gap between knowledge of appropriate care and the care actually delivered.ConclusionSocial franchising has received attention globally as a model for delivering high-quality care in rural areas in the developing world but supporting data are scarce. Our findings emphasize the need for sound empirical evidence before social franchising programmes are scaled up.

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Survey using incognito standardized patients shows poor quality care in China’s rural clinics

Cited by 139 publications

References 31 publications

Use of standardised patients to assess quality of tuberculosis care: a pilot, cross-sectional study

Use of standardised patients to assess quality of tuberculosis care: a pilot, cross-sectional study

Enhancing quality of medical care in low income and middle income countries through simulation-based initiatives: recommendations of the Simnovate Global Health Domain Group

Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India

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