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Is quality of care in RBF
focusing where it matters?
a call to action
ERIK JOSEPHSON, JESSICA GERGEN, MARTHA COE
NOVEMBER ...
2
QUALITY OF CARE IN RESULTS-BASED FINANCING
A GLOBAL ANALYSIS
- Collected so far
- 43 quality checklists from 3 regions
-...
3
DIMENSIONS OF QUALITY OF CARE
1. Resource Availability – The structural resources required to delivery
quality care (str...
4
100%
APPLYING THE DIMENSIONS OF QUALITY OF CARE
4774
914
16
1938
- 4,774 indicators
- 39 quality checklists
- 24 impleme...
5
100%
APPLYING THE DIMENSIONS OF QUALITY OF CARE
4774
914
16
1938
1160
575
171
- Available equipment, beds, surgery kits,...
6
100%
APPLYING THE DIMENSIONS OF QUALITY OF CARE
4774
914
16
1938
1160
575
171
- Availability of specific drugs
- Availab...
7
100%
APPLYING THE DIMENSIONS OF QUALITY OF CARE
4774
914
16
1938
1160
575
171
- Meetings organized, meeting minutes
- Fi...
8
100%
APPLYING THE DIMENSIONS OF QUALITY OF CARE
4774
914
16
1938
1160
575
171
- The knowledge of the clinician is tested...
9
100%
APPLYING THE DIMENSIONS OF QUALITY OF CARE
4774
914
16
1938
1160
575
171
3 types of indicator measuring effort
- Re...
10
100%
APPLYING THE DIMENSIONS OF QUALITY OF CARE
4774
914
16
1938
1160
575
171
Facility
Mgmt
Pharma
Availability
Compete...
11
100%
APPLYING THE DIMENSIONS OF QUALITY OF CARE
4774
914
16
1938
1160
575
171
Indicators looking at the
competence and ...
12
A CALL TO ACTION
- There is thus far limited evidence on what works for improving
quality outcomes
- 1. Is it appropria...
THIS STUDY WAS FUNDED BY THE UNITED STATES AGENCY FOR INTERNATIO NAL DEVELOPMENT UNDER
TRANSLATING RESEARCH INTO ACTION, C...
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How to build quality into the design of RbF Schemes - global analysis

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Erik josephson et al.

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How to build quality into the design of RbF Schemes - global analysis

  1. 1. Is quality of care in RBF focusing where it matters? a call to action ERIK JOSEPHSON, JESSICA GERGEN, MARTHA COE NOVEMBER 2015
  2. 2. 2 QUALITY OF CARE IN RESULTS-BASED FINANCING A GLOBAL ANALYSIS - Collected so far - 43 quality checklists from 3 regions - 39 latest versions and 4 older versions - Funded by governments, World Bank, USAID, CDC and KFW - Created a quality indicator database - More than 5,500 indicators in total - 4,774 indicators from the latest checklists - Indicator (as opposed to criteria to fulfill the indicator) defined as any measure with an associated score
  3. 3. 3 DIMENSIONS OF QUALITY OF CARE 1. Resource Availability – The structural resources required to delivery quality care (structural) 2. Pharmaceutical Availability – The pharmaceutical and consumable resources required to delivery quality care (structural) 3. Facility Management – The management processes required to ensure that the health facility functions optimally to deliver quality care (process) 4. Competence of Clinician – The clinician has the clinical knowledge required to care for, or diagnose and treat, patients (process) 5. Effort of Clinician – The clinician correctly applies appropriate clinical knowledge based on the latest medical teaching to deliver quality care (process) 6. Other – A variety of types of indicator which don’t fit easily into these other dimensions
  4. 4. 4 100% APPLYING THE DIMENSIONS OF QUALITY OF CARE 4774 914 16 1938 - 4,774 indicators - 39 quality checklists - 24 implementations - 22 countries 1160 575 171 The six dimensions applied to all 4,774 indicators Facility Mgmt Pharma Availability Competence OtherEffortResource Availability Total
  5. 5. 5 100% APPLYING THE DIMENSIONS OF QUALITY OF CARE 4774 914 16 1938 1160 575 171 - Available equipment, beds, surgery kits, etc - Presence or posting of trained, certified, skilled, qualified personnel to the facility - Available printed materials, protocols, etc Resource Availability Facility Mgmt Pharma Availability Competence OtherEffortResource Availability Total
  6. 6. 6 100% APPLYING THE DIMENSIONS OF QUALITY OF CARE 4774 914 16 1938 1160 575 171 - Availability of specific drugs - Availability of family planning methods Pharmaceutical Availability Facility Mgmt Pharma Availability Competence OtherEffortResource Availability Total
  7. 7. 7 100% APPLYING THE DIMENSIONS OF QUALITY OF CARE 4774 914 16 1938 1160 575 171 - Meetings organized, meeting minutes - Financial management reports - Business plan in place - Hygiene and sanitation plans and actions - Human resource management plans Facility Management Facility Mgmt Pharma Availability Competence OtherEffortResource Availability Total
  8. 8. 8 100% APPLYING THE DIMENSIONS OF QUALITY OF CARE 4774 914 16 1938 1160 575 171 - The knowledge of the clinician is tested by the verifier, generally asking the clinician what is the protocol in response to a certain diagnosis - Common example is knowing the detection criteria for early-stage TB Clinician Competence Facility Mgmt Pharma Availability Competence OtherEffortResource Availability Total
  9. 9. 9 100% APPLYING THE DIMENSIONS OF QUALITY OF CARE 4774 914 16 1938 1160 575 171 3 types of indicator measuring effort - Review of registers and charts by the verifier (749) - Direct observation of clinical interactions by the verifier (148) - Exit interviews with patients (17) Clinician Application and Effort Facility Mgmt Pharma Availability Competence OtherEffortResource Availability Total
  10. 10. 10 100% APPLYING THE DIMENSIONS OF QUALITY OF CARE 4774 914 16 1938 1160 575 171 Facility Mgmt Pharma Availability Competence OtherEffortResource Availability Total The majority of indicators are related to infrastructure and equipment (41%), facility management (24%) and the presence of pharmaceuticals (12%). Together these account for 77% of all indicators. Resources and Management
  11. 11. 11 100% APPLYING THE DIMENSIONS OF QUALITY OF CARE 4774 914 16 1938 1160 575 171 Indicators looking at the competence and effort of clinicians account for 19% of all quality of care indicators among the 39 quality checklists analyzed. These are tested through register and chart review (16%), questioning the clinician (<1%) and direct clinical observation (3%). Clinician – Patient Interaction Facility Mgmt Pharma Availability Competence OtherEffortResource Availability Total
  12. 12. 12 A CALL TO ACTION - There is thus far limited evidence on what works for improving quality outcomes - 1. Is it appropriate that RBF focuses so much on infrastructure, availability of equipment and drugs, and facility management? - 2. Should we be doing more assessment of clinician knowledge and direct observation of the patient-clinician interaction? - The RBF community should assess which of these different types of indicators more directly lead to quality outcomes, AND - Rigorously assess whether these indicators best respond to financial, or non-financial, incentives - 3. Could we develop a framework for practitioners to develop quality checklists dependent on the health system context?
  13. 13. THIS STUDY WAS FUNDED BY THE UNITED STATES AGENCY FOR INTERNATIO NAL DEVELOPMENT UNDER TRANSLATING RESEARCH INTO ACTION, COOPERATIVE AGREEMENT NO. GHS -A-00-09-00015-00 ASANTE

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