横断面研究比较病例情景和记录审查，以衡量乌干达西部综合社区病例管理护理的质量。

A cross-sectional study comparing case scenarios and record review to measure quality of Integrated Community Case Management care in western Uganda.

机构信息

Massachusetts General Hospital, Boston, MA, USA.

Harvard Medical School, Boston, MA, USA.

出版信息

Trans R Soc Trop Med Hyg. 2021 Jun 2;115(6):627-633. doi: 10.1093/trstmh/traa097.

DOI:10.1093/trstmh/traa097

PMID:33002128

Abstract

BACKGROUND

In Integrated Community Case Management (iCCM), village health workers (VHW) assess and treat malaria, pneumonia and diarrhea using a clinical algorithm. Study objectives included: 1) Compare VHWs' performance on case scenario exercises to record review data; 2) assess impact of formal education on performance in the case scenario exercises.

METHODS

36 VHWs in Bugoye Subcounty, Uganda completed the case scenarios exercise, which included video case scenarios and brief oral case vignettes, between July 2017 and February 2018. We obtained clinical records for all iCCM encounters in the same time period.

RESULTS

In the video case scenarios, 45% of mock patients received all correct management steps (including all recommended education), while 94% received all critical management steps. Based on the level of data available from record review, 74% of patients in the record review dataset received overall correct management compared to 94% in the video case scenarios. In the case scenarios, VHWs with primary school education performed similarly to those with some or all secondary school education.

CONCLUSIONS

The case scenarios produced higher estimates of quality of care than record review. VHWs often omitted recommended health education topics in the case scenarios. Level of formal education did not appear to influence performance in the case scenarios.

摘要

背景

在综合社区病例管理（iCCM）中，乡村卫生工作者（VHW）使用临床算法评估和治疗疟疾、肺炎和腹泻。研究目的包括：1）比较 VHW 在病例情景演练中的表现与记录回顾数据；2）评估正规教育对病例情景演练表现的影响。

方法

2017 年 7 月至 2018 年 2 月期间，乌干达 Bugoye 分区的 36 名 VHW 完成了病例情景演练，其中包括视频病例情景和简短的口头病例描述。我们在同一时间段内获得了所有 iCCM 就诊的临床记录。

结果

在视频病例情景中，45%的模拟患者接受了所有正确的管理步骤（包括所有推荐的教育），而 94%的患者接受了所有关键的管理步骤。根据记录回顾中可获得的数据水平，与视频病例情景中 94%的患者相比，记录回顾数据集的 74%的患者接受了总体正确的管理。在病例情景中，只有小学教育背景的 VHW 与具有部分或全部中学教育背景的 VHW 表现相似。