Kihuba Elesban, Gathara David, Mwinga Stephen, Mulaku Mercy, Kosgei Rose, Mogoa Wycliffe, Nyamai Rachel, English Mike
Ministry of Health, Government of Kenya, Nairobi, Kenya; The Health Services, Implementation Research and Clinical Excellence (SIRCLE) Collaboration, Nairobi, Kenya;
KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
Glob Health Action. 2014 Jul 31;7:24859. doi: 10.3402/gha.v7.24859. eCollection 2014.
Hospital management information systems (HMIS) is a key component of national health information systems (HIS), and actions required of hospital management to support information generation in Kenya are articulated in specific policy documents. We conducted an evaluation of core functions of data generation and reporting within hospitals in Kenya to facilitate interpretation of national reports and to provide guidance on key areas requiring improvement to support data use in decision making.
The survey was a cross-sectional, cluster sample study conducted in 22 hospitals in Kenya. The statistical analysis was descriptive with adjustment for clustering.
Most of the HMIS departments complied with formal guidance to develop departmental plans. However, only a few (3/22) had carried out a data quality audit in the 12 months prior to the survey. On average 3% (range 1-8%) of the total hospital income was allocated to the HMIS departments. About half of the records officer positions were filled and about half (13/22) of hospitals had implemented some form of electronic health record largely focused on improving patient billing and not linked to the district HIS. Completeness of manual patient registers varied, being 90% (95% CI 80.1-99.3%), 75.8% (95% CI 68.7-82.8%), and 58% (95% CI 50.4-65.1%) in maternal child health clinic, maternity, and pediatric wards, respectively. Vital events notification rates were low with 25.7, 42.6, and 71.3% of neonatal deaths, infant deaths, and live births recorded, respectively. Routine hospital reports suggested slight over-reporting of live births and under-reporting of fresh stillbirths and neonatal deaths.
Study findings indicate that the HMIS does not deliver quality data. Significant constraints exist in data quality assurance, supervisory support, data infrastructure in respect to information and communications technology application, human resources, financial resources, and integration.
医院管理信息系统（HMIS）是国家卫生信息系统（HIS）的关键组成部分，肯尼亚的特定政策文件明确了医院管理为支持信息生成所需采取的行动。我们对肯尼亚医院内数据生成和报告的核心功能进行了评估，以促进对国家报告的解读，并为需要改进的关键领域提供指导，以支持决策中的数据使用。
该调查是在肯尼亚22家医院进行的横断面整群抽样研究。统计分析为描述性分析，并对聚类进行了调整。
大多数HMIS部门遵守了制定部门计划的正式指导。然而，在调查前的12个月内，只有少数（3/22）进行了数据质量审核。HMIS部门平均获得的资金占医院总收入的3%（范围为1 - 8%）。约一半的记录员职位有人任职，约一半（13/22）的医院实施了某种形式的电子健康记录，主要侧重于改善患者计费，且未与地区HIS相连。手工患者登记册的完整性各不相同，妇幼保健诊所、产科和儿科病房的完整性分别为90%（95%可信区间80.1 - 99.3%）、75.8%（95%可信区间68.7 - 82.8%）和58%（95%可信区间50.4 - 65.1%）。重要事件报告率较低，新生儿死亡、婴儿死亡和活产的报告率分别为25.7%、42.6%和71.3%。常规医院报告显示活产略有虚报，新鲜死产和新生儿死亡报告不足。
研究结果表明，HMIS未能提供高质量数据。在数据质量保证、监督支持、信息通信技术应用方面的数据基础设施、人力资源、财政资源以及整合方面存在重大制约因素。
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