The Effect of a Continuous Quality Improvement Intervention on Retention-In-Care at 6 Months Postpartum in a PMTCT Program in Northern Nigeria: Results of a Cluster Randomized Controlled Study

Oyeledun, Bolanle; Phillips, Abimbola; Oronsaye, Frank; Alo, Oluwafemi David; Shaffer, Nathan; Osibo, Bamidele; Imarhiagbe, Collins; Ogirima, Francis; Ajibola, Abiola; Ezebuka, Obioma; Ojong-Etta, Bebia; Obi, Adaobi; Falade, J.A.; Uthman, Adunbi Kareem; Famuyide, Busuyi; Odoh, Deborah; Becquet, Renaud

doi:10.1097/qai.0000000000001363

Cited by 33 publications

(60 citation statements)

References 16 publications

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“…Most RCTs were carried out in high-income countries, with 15 in the USA [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54], two in the Netherlands [55,56], two in Canada [57,58], two in the UK [59,60], and one each in Sweden [61] and Spain [62]. Four RCTs were undertaken in the middle-or low-income countries, specifically in India [63], Mexico [64], Nigeria [65], and Malawi [66]. Another RCT was conducted across multiple African countries [67].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The clinical setting for the RCTs was mainly in primary (i.e., general practice) (13 RCTs) [40, 41, 43, 44, 48-53, 58, 62, 64] or secondary care (i.e., hospitals) (10 RCTs) [45, 54, 55, 59-61, 63, 66-68]. The remaining five RCTs were set in substance misuse clinics [69], community outreach [65], social services, and social care [47,57] or tertiary care [56]. Most RCTs were published recently, with 19 RCTs published since 2010 [40, Under half of outcomes Less than half of the outcomes in studies showed a statistically significant benefit from CQI versus its comparator.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In most subgroups, over 50% of RCTs reported no statistically significant benefit from CQI compared to the non-CQI comparator on all the outcomes assessed. For the outcomes defined as "other," this included all three RCTs finding no statistically significant effect [46,50,65]. Root cause analysis 1 0 (0%) 0 (0%) 0 (0%) 1 (100.0%) 0 (0%) 1 (100.0%) Other 2 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 (100.0%) 0 (0%)…”

Section: Sub-group Analysesmentioning

confidence: 99%

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The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review

Hill¹,

Stephani²,

Sapple³

et al. 2020

Implementation Sci

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Background: Efforts to improve the quality, safety, and efficiency of health care provision have often focused on changing approaches to the way services are organized and delivered. Continuous quality improvement (CQI), an approach used extensively in industrial and manufacturing sectors, has been used in the health sector. Despite the attention given to CQI, uncertainties remain as to its effectiveness given the complex and diverse nature of health systems. This review assesses the effectiveness of CQI across different health care settings, investigating the importance of different components of the approach. Methods: We searched 11 electronic databases: MEDLINE, CINAHL, EMBASE, AMED, Academic Search Complete, HMIC, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trials, LISTA, and NHS EED to February 2019. Also, we searched reference lists of included studies and systematic reviews, as well as checking published protocols for linked papers. We selected randomized controlled trials (RCTs) within health care settings involving teams of health professionals, evaluating the effectiveness of CQI. Comparators included current usual practice or different strategies to manage organizational change. Outcomes were health care professional performance or patient outcomes. Studies were published in English. Results: Twenty-eight RCTs assessed the effectiveness of different approaches to CQI with a non-CQI comparator in various settings, with interventions differing in terms of the approaches used, their duration, meetings held, people involved, and training provided. All RCTs were considered at risk of bias, undermining their results. Findings suggested that the benefits of CQI compared to a non-CQI comparator on clinical process, patient, and other outcomes were limited, with less than half of RCTs showing any effect. Where benefits were evident, it was usually on clinical process measures, with the model used (i.e., Plan-Do-Study-Act, Model of Improvement), the meeting type (i.e., involving leaders discussing implementation) and their frequency (i.e., weekly) having an effect. None considered socioeconomic health inequalities.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Sub-group Analysesmentioning

confidence: 99%

See 1 more Smart Citation

The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review

Hill¹,

Stephani²,

Sapple³

et al. 2020

Implementation Sci

View full text Add to dashboard Cite

show abstract

“…Rates of retention were no different by study arm regardless of the definition used. 11 Again, the study team invested enormous effort and commitment to support local health facility teams to learn and implement CQI and the Breakthrough Series methods. 12 Facility teams enthusiastically engaged in the CQI process and actively tested change ideas—more than 41 in total across the intervention sites.…”

Section: Health Systems' Intervention and Retention In Care And Othermentioning

confidence: 99%

Improving Retention in Care Among Pregnant Women and Mothers Living With HIV: Lessons From INSPIRE and Implications for Future WHO Guidance and Monitoring

Rollins

Essajee

Bellare

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Identifying women living with HIV, initiating them on lifelong antiretroviral treatment (ART), and retaining them in care are among the important challenges facing this generation of health care managers and public health researchers. Implementation research attempts to solve a wide range of implementation problems by trying to understand and work within real-world conditions to find solutions that have a measureable impact on the outcomes of interest. Implementation research is distinct from clinical research in many ways yet demands similar standards of conceptual thinking and discipline to generate robust evidence that can be, to some extent, generalized to inform policy and service delivery. In 2011, the World Health Organization (WHO), with funding from Global Affairs Canada, began support to 6 implementation research projects in Malawi, Nigeria, and Zimbabwe. All focused on evaluating approaches for improving rates of retention in care among pregnant women and mothers living with HIV and ensuring their continuation of ART. This reflected the priority given by ministries of health, program implementers, and researchers in each country to the importance of women living with HIV returning to health facilities for routine care, adherence to ART, and improved health outcomes. Five of the studies were cluster randomized controlled trials, and 1 adopted a matched cohort design. Here, we summarize some of the main findings and key lessons learned. We also consider some of the broader implications, remaining knowledge gaps, and how implementation research is integral to, and essential for, global guideline development and to inform HIV/AIDS strategies.

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“…In this study, peer support and community health worker support were not statistically significant predictors of missed visits. This is not surprising since most community interventions have not been proven to improve retention in PMTCT [13].…”

Section: Discussionmentioning

confidence: 91%

Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) Visits and Associated Programmatic Predictors: A Pilot Study

Ndaimani¹,

Chitsike²,

Haruzivishe³

et al. 2017

AID

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Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) visits have contributed to the delayed achievement of elimination of mother-to-child transmission of HIV. Missed visits promote attrition from prevention of mother-to-child transmission of HIV program and antiretroviral drug resistance. The purpose of the study was to determine the prevalence of missed PMTCT visits and its associated predictors. A descriptive cross sectional survey was carried out at a District Hospital in Goromonzi, Zimbabwe. Fifty-three women completed closed-ended questionnaires pertaining to PMTCT visits and exposure to PMTCT activities. A total of 24.5% missed at least one scheduled PMTCT visit. Statistically significant predictors of not missing a PMTCT visit were satisfaction with family support (β = −0.73, p = 0.029) and level of satisfaction with PMTCT services (β = −0.00076; p = 0.04). The number of days by which scheduled visits were missed were inversely correlated with visit number (β = −2.99, p = 0.04). Enhanced family support and quality improvement to improve patient satisfaction may reduce missed visits. Availing women with a more active role in PMTCT may also reduce the prevalence of missed visits.

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The Effect of a Continuous Quality Improvement Intervention on Retention-In-Care at 6 Months Postpartum in a PMTCT Program in Northern Nigeria: Results of a Cluster Randomized Controlled Study

Abstract: CQI as implemented in this study did not differ across study arms in the rates of retention. Several intervention design or implementation issues or other contextual constraints may explain the absence of effect.

Cited by 33 publications

References 16 publications

The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review

The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review

Improving Retention in Care Among Pregnant Women and Mothers Living With HIV: Lessons From INSPIRE and Implications for Future WHO Guidance and Monitoring

Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) Visits and Associated Programmatic Predictors: A Pilot Study

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