Mwaniki Paul, Ayieko Philip, Todd Jim, English Mike
KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya.
BMC Health Serv Res. 2014 Jul 18;14:312. doi: 10.1186/1472-6963-14-312.
In assessing quality of care in developing countries, retrospectively collected data are usually used given their availability. Retrospective data however suffer from such biases as recall bias and non-response bias. Comparing results obtained using prospectively and retrospectively collected data will help validate the use of the easily available retrospective data in assessing quality of care in past and future studies.
Prospective and retrospective datasets were obtained from a cluster randomized trial of a multifaceted intervention aimed at improving paediatric inpatient care conducted in eight rural Kenyan district hospitals by improving management of children admitted with pneumonia, malaria and diarrhea and/or dehydration. Four hospitals received a full intervention and four a partial intervention. Data were collected through 3 two weeks surveys conducted at baseline, after 6 and 18 months. Retrospective data was sampled from paediatric medical records of patients discharged in the preceding six months of the survey while prospective data was collected from patients discharged during the two week period of each survey. Risk Differences during post-intervention period of 16 quality of care indicators were analyzed separately for prospective and retrospective datasets and later plotted side by side for comparison.
For the prospective data there was strong evidence of an intervention effect for 8 of the indicators and weaker evidence of an effect for one indicator, with magnitude of effect sizes varying from 23% to 60% difference. For the retrospective data, 10 process (these include the 8 indicators found to be statistically significant in prospective data analysis) indicators had statistically significant differences with magnitude of effects varying from 10% to 42%. The bar-graph comparing results from the prospective and retrospective datasets showed similarity in terms of magnitude of effects and statistical significance for all except two indicators.
Multifaceted interventions can help improve adoption of clinical guidelines and hence improve the quality of care. The similar inference reached after analyses based on prospective assessment of case management is a useful finding as it supports the utility of work based on examination of retrospectively assembled case records allowing longer time periods to be studied while constraining costs.
Current Controlled Trials ISRCTN42996612. Trial registration date: 20/11/2008.
在评估发展中国家的医疗质量时，鉴于回顾性收集的数据易于获取，通常会使用此类数据。然而，回顾性数据存在回忆偏倚和无应答偏倚等偏差。比较前瞻性和回顾性收集的数据所得到的结果，将有助于验证在过去和未来研究中使用易于获取的回顾性数据来评估医疗质量的有效性。
前瞻性和回顾性数据集来自一项整群随机试验，该试验是一项多方面干预措施，旨在通过改善肯尼亚八个农村地区医院对肺炎、疟疾和腹泻及/或脱水患儿的管理，来提高儿科住院护理质量。四家医院接受全面干预，四家接受部分干预。在基线、6个月和18个月后通过3次为期两周的调查收集数据。回顾性数据从调查前六个月出院患者的儿科病历中抽取，而前瞻性数据从每次调查两周期间出院的患者中收集。分别对前瞻性和回顾性数据集分析16项护理质量指标干预后时期的风险差异，随后并排绘制以进行比较。
对于前瞻性数据，有强有力的证据表明8项指标存在干预效果，有较弱的证据表明一项指标存在效果，效果大小差异从23%到60%不等。对于回顾性数据，10项过程指标（这些指标包括在前瞻性数据分析中发现具有统计学显著性的8项指标）存在统计学显著性差异，效果大小从10%到42%不等。比较前瞻性和回顾性数据集结果的柱状图显示，除两项指标外，所有指标在效果大小和统计学显著性方面都具有相似性。
多方面干预措施有助于提高临床指南的采用率，从而提高护理质量。基于病例管理前瞻性评估分析后得出的类似推断是一项有用的发现，因为它支持基于回顾性整理病例记录检查的工作的效用，这样可以在控制成本的同时研究更长的时间段。
当前对照试验ISRCTN42996612。试验注册日期：2008年11月20日。
