Swiss TPH, Basel, Switzerland.
University of Basel, Basel, Switzerland.
PLoS One. 2018 Nov 26;13(11):e0207233. doi: 10.1371/journal.pone.0207233. eCollection 2018.
Quality of care is a difficult parameter to measure. With the introduction of digital algorithms based on the Integrated Management of Childhood Illness (IMCI), we are interested to understand if the adherence to the guidelines improved for a better quality of care for children under 5 years old.
More than one year after the introduction of digital algorithms, we carried out two cross sectional studies to assess the improvements in comparison with the situation prior to the implementation of the project, in two Basic Health Centres in Kabul province. One survey was carried out inside the consultation room and was based on the direct observation of 181 consultations of children aged 2 months to 5 years old, using a checklist completed by a senior physicians. The second survey queried 181 caretakers of children outside the health facility for their opinion about the consultation carried out through the tablet and prescriptions and medications given.
We measured the quality of care as adherence to the IMCI's guidelines. The study evaluated the quality of the physical examination and the therapies prescribed with a special attention to antibiotic prescription. We noticed a dramatic improvement (p<0.05) of several indicators following the introduction of digital algorithms. The baseline physical examination was appropriate only for 23.8% [IC% 19.9-28.1] of the patients, 34.5% [IC% 30.0-39.2] received a correct treatment and 86.1% [IC% 82.4-89.2] received at least one antibiotic. With the introduction of digital algorithms, these indicators statistically improved respectively to 84.0% [IC% 77.9-88.6], >85% and less than 30%.
Our findings suggest that digital algorithms improve quality of care by applying the guidelines more effectively. Our experience should encourage to test this tool in different settings and to scale up its use at province/state level.
医疗质量是一个难以衡量的参数。随着基于儿童综合疾病管理（IMCI）的数字算法的引入，我们有兴趣了解对于 5 岁以下儿童的医疗服务质量是否因更好地遵循指南而得到改善。
在数字算法引入一年多后，我们在喀布尔省的两个基础保健中心进行了两项横断面研究，以评估与项目实施前的情况相比的改进情况。一项调查是在咨询室内进行的，通过使用高级医生填写的检查表，直接观察了 181 名 2 个月至 5 岁儿童的咨询情况。第二项调查询问了 181 名在医疗机构外的儿童照顾者对通过平板电脑进行的咨询、开出的处方和药物的意见。
我们将医疗服务质量衡量为对 IMCI 指南的遵循程度。该研究评估了体格检查的质量和开出的治疗方法，特别关注抗生素的处方。我们注意到，在引入数字算法后，几个指标有了显著的改善（p<0.05）。基线体格检查仅适用于 23.8%[95%置信区间（CI）19.9-28.1]的患者，34.5%[95%CI 30.0-39.2]接受了正确的治疗，86.1%[95%CI 82.4-89.2]至少接受了一种抗生素。引入数字算法后，这些指标分别统计上提高到 84.0%[95%CI 77.9-88.6]、>85%和小于 30%。
我们的发现表明，数字算法通过更有效地应用指南来提高医疗质量。我们的经验应该鼓励在不同环境中测试该工具，并在省/州一级扩大其使用。
