Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
Neglected Tropical Disease, WHO Timor-Leste Office United Nations House Caicoli street, Dili, Timor-Leste.
Int J Qual Health Care. 2020 Jul 20;32(6):364-372. doi: 10.1093/intqhc/mzaa052.
To determine the effect of social accountability strategies on pediatric quality of care.
A non-randomized quasi experimental study was conducted in four districts in Cambodia and all operational public health facilities were included.
Five patients under 5 years and their caretakers were randomly selected in each facility.
To determine the effect of maternal and child health interventions integrating citizen voice and action using community scorecards on quality of pediatric care.
Patient observations were conducted to determine quality of screening and counseling, followed by exit interviews with caretakers.
Results indicated significant differences between intervention and comparison facilities; screening by Integrated Management of Childhood Illness (IMCI) trained providers (100% vs 67%, P < 0.019), screening for danger signs; ability to drink/breastfeed (100% vs 86.7%, P < 0.041), lethargy (86.7% vs 40%, P < 0.004) and convulsions (83.3 vs 46.7%, P < 0.023). Screening was significantly higher for patients in the intervention facilities for edema (56.7% vs 6.7%, P < 0.000), immunization card (90% vs 40%, P < 0.002), child weight (100 vs 86.7, P < 0.041) and checking growth chart (96.7% vs 66.7%, P < 0.035). The IMCI index, constructed from key performance indicators, was significantly higher for patients in the intervention facilities than comparison facilities (screening index 8.8 vs 7.0, P < 0.018, counseling index 2.7 vs 1.5, P < 0.001). Predictors of screening quality were child age, screening by IMCI trained provider, wealthier quintiles and intervention facilities.
The institution of social accountability mechanisms to engage communities and facility providers showed some improvements in quality of care for common pediatric conditions, but socioeconomic disparities were evident.
确定社会问责策略对儿科护理质量的影响。
在柬埔寨的四个地区进行了一项非随机准实验研究，包括所有运营公共卫生设施。
每个设施中随机选择 5 名 5 岁以下的患者及其看护人。
确定将公民声音和行动纳入社区记分卡的妇幼保健干预措施对儿科护理质量的影响。
对患者进行观察以确定筛查和咨询的质量，然后对看护人进行出口访谈。
干预和对照设施之间存在显著差异；经综合儿童疾病管理（IMCI）培训的提供者进行的筛查（100%对 67%，P<0.019），筛查危险体征；能够饮水/哺乳（100%对 86.7%，P<0.041）、昏睡（86.7%对 40%，P<0.004）和惊厥（83.3%对 46.7%，P<0.023）。在干预设施中，患者的水肿（56.7%对 6.7%，P<0.000）、免疫接种卡（90%对 40%，P<0.002）、儿童体重（100%对 86.7%，P<0.041）和检查生长图表（96.7%对 66.7%，P<0.035）的筛查率明显更高。从关键绩效指标构建的 IMCI 指数，干预设施中患者的指数明显高于对照设施（筛查指数 8.8 对 7.0，P<0.018，咨询指数 2.7 对 1.5，P<0.001）。筛查质量的预测因素包括儿童年龄、经 IMCI 培训的提供者进行筛查、较富裕的五分位数和干预设施。
实施社会问责机制，让社区和设施提供者参与其中，在改善常见儿科疾病的护理质量方面取得了一些进展，但社会经济差距仍然明显。
