Mengistu Birkety, Karim Ali Mehyar, Eniyew Andargachew, Yitabrek Abraham, Eniyew Antenane, Tsegaye Sentayehu, Muluye Fekadu, Tesfaye Hailu, Demeke Berhanu, Marsh David R
Ethiop Med J. 2014 Oct;52 Suppl 3:73-81.
The Performance Review and Clinical Mentoring Meeting (PRCMM) is an approach to improve and sustain Health Extension Worker (HEW) skills and performance in integrated Community Case Management (iCCM).
To compare HEW performance in recording case management before and after they participated in PRCMM.
We conducted a historical cohort analysis of iCCM case records between September 2010 and December 2012 from 622 randomly selected health posts representing 31 intervention woredas (districts) of Amhara, Oromia and Southern Nations Nationalities and Peoples' Regions. We used longitudinal regression analysis comparing the trend in the consistency of the classification with the assessment, treatment and follow-up date as well as caseload in the periods before and after PRCMM, with 5511 and 7901 case records, respectively.
Overall consistency improved after PRCMM for all common classifications as follows: pneumonia (54.1% [95% CI: 47.7%-60.5%] vs. 78.2% [73.9%-82.5%]), malaria (50.8% [42.9%-58.7%] vs. 78.9% [73.4%- 84.4%]), and diarrhea (33.7% [27.9%-39.5%] vs. 70.0% [64.7%-75.3%]). This improvement was consistently observed comparing the six months before and the six months after PRCMM in all the common classifications except for malaria where the improvement observed during the first three post-PRCMM months disappeared during the fifth and sixth months. Caseload increased significantly after PRCMM (6.6 [95% CI: 5.9-7.3] vs. 9.2 [8.5-9.9] cases/health post/month).
PRCMM seemed to improve iCCM performance of HEWs and should be integrated within the PHC system and given about every six months, at least at first, to sustain improvement.
绩效评估与临床指导会议（PRCMM）是一种用于提高和维持健康推广工作者（HEW）在综合社区病例管理（iCCM）方面技能和绩效的方法。
比较健康推广工作者在参加绩效评估与临床指导会议前后记录病例管理情况的表现。
我们对2010年9月至2012年12月期间来自622个随机选取的卫生站的iCCM病例记录进行了历史队列分析,这些卫生站代表阿姆哈拉、奥罗米亚以及南方各族州的31个干预区（县）。我们使用纵向回归分析比较了绩效评估与临床指导会议前后分类与评估、治疗及随访日期一致性的趋势以及病例量，前后分别有5511份和7901份病例记录。
绩效评估与临床指导会议后，所有常见分类的总体一致性均有所提高，具体如下：肺炎（54.1%[置信区间95%：47.7%-60.5%]对78.2%[73.9%-82.5%]）、疟疾（50.8%[42.9%-58.7%]对78.9%[73.4%-84.4%]）和腹泻（33.7%[27.9%-39.5%]对70.0%[64.7%-75.3%]）。在绩效评估与临床指导会议前六个月和后六个月进行比较时，除疟疾外，所有常见分类中均持续观察到这种改善，在疟疾方面，绩效评估与临床指导会议后前三个月观察到的改善在第五和第六个月消失。绩效评估与临床指导会议后病例量显著增加（每个卫生站每月6.6例[置信区间95%：5.9-7.3]对9.2例[8.5-9.9]）。
绩效评估与临床指导会议似乎提高了健康推广工作者的iCCM绩效，应纳入初级卫生保健系统，至少在开始时每六个月进行一次，以维持改善效果。
