Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
BMC Health Serv Res. 2012 Jul 9;12:196. doi: 10.1186/1472-6963-12-196.
High quality program data is critical for managing, monitoring, and evaluating national HIV treatment programs. By 2009, the Malawi Ministry of Health had initiated more than 270,000 patients on HIV treatment at 377 sites. Quarterly supervision of these antiretroviral therapy (ART) sites ensures high quality care, but the time currently dedicated to exhaustive record review and data cleaning detracts from other critical components. The exhaustive record review is unlikely to be sustainable long term because of the resources required and increasing number of patients on ART. This study quantifies the current levels of data quality and evaluates Lot Quality Assurance Sampling (LQAS) as a tool to prioritize sites with low data quality, thus lowering costs while maintaining sufficient quality for program monitoring and patient care.
In January 2010, a study team joined supervision teams at 19 sites purposely selected to reflect the variety of ART sites. During the exhaustive data review, the time allocated to data cleaning and data discrepancies were documented. The team then randomly sampled 76 records from each site, recording secondary outcomes and the time required for sampling.
At the 19 sites, only 1.2% of records had discrepancies in patient outcomes and 0.4% in treatment regimen. However, data cleaning took 28.5 hours in total, suggesting that data cleaning for all 377 ART sites would require over 350 supervision-hours quarterly. The LQAS tool accurately identified the sites with the low data quality, reduced the time for data cleaning by 70%, and allowed for reporting on secondary outcomes.
Most sites maintained high quality records. In spite of this, data cleaning required significant amounts of time with little effect on program estimates of patient outcomes. LQAS conserves resources while maintaining sufficient data quality for program assessment and management to allow for quality patient care.
高质量的项目数据对于管理、监测和评估国家艾滋病治疗方案至关重要。截至 2009 年，马拉维卫生部已在 377 个地点为 27 万多名患者提供了艾滋病毒治疗。对这些抗逆转录病毒疗法（ART）地点进行季度监督确保了高质量的护理，但目前用于详尽的记录审查和数据清理的时间却因所需资源和接受抗逆转录病毒治疗的患者人数不断增加而减少。由于所需资源以及接受抗逆转录病毒治疗的患者人数不断增加，详尽的记录审查不太可能长期持续下去。本研究量化了当前的数据质量水平，并评估了批量质量保证抽样（LQAS）作为一种工具，用于确定数据质量较低的地点，从而在保持足够的方案监测和患者护理质量的同时降低成本。
2010 年 1 月，一个研究小组加入了 19 个专门挑选的地点的监督小组，以反映各种 ART 地点。在详尽的数据审查期间，记录用于数据清理和数据差异的时间。然后，团队从每个地点随机抽取 76 份记录，记录次要结果和抽样所需的时间。
在 19 个地点，只有 1.2%的记录在患者结局和 0.4%的记录在治疗方案方面存在差异。然而，数据清理总共需要 28.5 个小时，这表明对所有 377 个 ART 地点进行数据清理将需要每季度超过 350 个监督小时。LQAS 工具准确地确定了数据质量较低的地点，将数据清理时间减少了 70%，并允许报告次要结果。
大多数地点都保持了高质量的记录。尽管如此，数据清理仍需要大量时间，对方案估计的患者结局影响不大。LQAS 可以在保持足够的数据质量以进行方案评估和管理的同时，节省资源，从而允许进行高质量的患者护理。
