Broughton Edward, Saley Zakari, Boucar Maina, Alagane Dondi, Hill Kathleen, Marafa Aicha, Asma Yaroh, Sani Karimou
USAID Health Care Improvement Project, University Research Co., Bethesda, Maryland, USA.
Int J Health Care Qual Assur. 2013;26(3):250-61. doi: 10.1108/09526861311311436.
The purpose of this paper is to describe a quality improvement collaborative conducted in 33 Nigerian facilities to improve maternal and newborn care outcomes by increasing compliance with high-impact, evidence-based care standards. Intervention costs and cost-effectiveness were examined and costs to the Niger Health Ministry (MoH) were estimated if they were to scale-up the intervention to additional sites.
DESIGN/METHODOLOGY/APPROACH: Facility-based maternal care outcomes and costs from pre-quality improvement collaborative baseline monitoring data in participating facilities from January to May 2006 were compared with outcomes and costs from the same facilities from June 2008 to September 2008. Cost data were collected from project accounting records. The MoH costs were determined from interviews with clinic managers and quality improvement teams. Effectiveness data were obtained from facilities' records.
The average delivery-cost decreased from $35 before to $28 after the collaborative. The USAID/HCI project's incremental cost was $2.43/delivery. The collaborative incremental cost-effectiveness was $147/disability-adjusted life year averted. If the MoH spread the intervention to other facilities, substantive cost-savings and improved health outcomes can be predicted.
The intervention achieved significant positive health benefits for a low cost. The Niger MoH can expect approximately 50 per cent return on its investment if it implements the collaborative in new facilities. The improvement collaborative approach can improve health and save health care resources.
ORIGINALITY/VALUE: This is one of the first studies known to examine collaborative quality improvement and economic efficiency in a developing country.
本文旨在描述在尼日利亚33家医疗机构开展的一项质量改进合作项目，通过提高对具有重大影响的循证护理标准的依从性来改善孕产妇和新生儿护理结局。研究考察了干预成本和成本效益，并估算了尼日利亚卫生部（MoH）若将该干预措施推广至其他机构所需的成本。
设计/方法/途径：将参与项目的医疗机构在2006年1月至5月质量改进合作项目前基线监测数据中的孕产妇护理结局及成本，与这些机构在2008年6月至9月期间的结局及成本进行比较。成本数据从项目会计记录中收集。卫生部的成本通过与诊所经理和质量改进团队的访谈确定。有效性数据从各机构的记录中获取。
合作开展后，平均分娩成本从之前的35美元降至28美元。美国国际开发署/健康护理改善项目的增量成本为每次分娩2.43美元。合作项目的增量成本效益为每避免一个伤残调整生命年147美元。如果卫生部将该干预措施推广至其他机构，预计可实现大幅成本节约并改善健康结局。
该干预措施以低成本取得了显著的积极健康效益。如果尼日利亚卫生部在新机构实施该合作项目，预计投资回报率约为50%。质量改进合作方法可改善健康状况并节省医疗资源。
原创性/价值：这是已知的最早在发展中国家考察合作质量改进和经济效率的研究之一。
