Datta Vikram, Srivastava Sushil, Garde Rahul, Mehta Rajesh, Livesley Nigel, Sawleshwarkar Kedar, Pemde Harish, Patnaik Suprabha K, Sooden Ankur, Singh Mahtab, John Susy Sarah, Pradeep Jeena, Vig Anupa, Kumar Achala, Singh Vivek, Bhatia Vandana, Garg Bishan Singh, Baswal Dinesh
Neonatology, Kalawati Saran Children's Hospital, New Delhi, Delhi, India
Neonatology, Lady Hardinge Medical College, New Delhi, Delhi, India.
BMJ Open Qual. 2021 Jul;10(Suppl 1). doi: 10.1136/bmjoq-2021-001449.
Inadequate quality of care has been identified as one of the most significant challenges to achieving universal health coverage in low-income and middle-income countries. To address this WHO-SEARO, the point of care quality improvement (POCQI) method has been developed. This paper describes developing a dynamic framework for the implementation of POCQI across India from 2015 to 2020.
A total of 10 intervention strategies were designed as per the needs of the local health settings. These strategies were implemented across 10 states of India, using a modification of the 'translating research in practice' framework. Healthcare professionals and administrators were trained in POCQI using a combination of onsite and online training methods followed by coaching and mentoring support. The implementation strategy changed to a fully digital community of practice platform during the active phase of the COVID-19 pandemic. Dashboard process, outcome indicators and crude cost of implementation were collected and analysed across the implementation sites.
Three implementation frameworks were evolved over the study period. The combined population benefitting from these interventions was 103 million. A pool of QI teams from 131 facilities successfully undertook 165 QI projects supported by a pool of 240 mentors over the study period. A total of 21 QI resources and 6 publications in peer-reviewed journals were also developed. The average cost of implementing POCQI initiatives for a target population of one million was US$ 3219. A total of 100 online activities were conducted over 6 months by the digital community of practice. The framework has recently extended digitally across the South-East Asian region.
The development of an implementation framework for POCQI is an essential requirement for the initiative's successful country-wide scale. The implementation plan should be flexible to the healthcare system's needs, target population and the implementing agency's capacity and amenable to multiple iterative changes.
医疗服务质量欠佳已被视为低收入和中等收入国家实现全民健康覆盖面临的最重大挑战之一。为应对这一问题，世卫组织东南亚区域办事处（WHO-SEARO）开发了即时医疗质量改进（POCQI）方法。本文描述了2015年至2020年期间在印度实施POCQI的动态框架的开发过程。
根据当地卫生环境的需求共设计了10项干预策略。这些策略在印度的10个邦实施，采用了“将研究转化为实践”框架的一种变体。医疗保健专业人员和管理人员通过现场培训和在线培训相结合的方式接受POCQI培训，随后获得辅导和指导支持。在新冠疫情活跃阶段，实施策略转变为完全数字化的实践社区平台。在各实施地点收集并分析了仪表板流程、结果指标和实施的粗略成本。
在研究期间形成了三个实施框架。受益于这些干预措施的总人口为1.03亿。在研究期间，来自131个机构的质量改进团队在240名导师的支持下成功开展了165个质量改进项目。还开发了21种质量改进资源并在同行评审期刊上发表了6篇论文。针对100万目标人群实施POCQI计划的平均成本为3219美元。实践社区在6个月内共开展了100项在线活动。该框架最近已在东南亚区域实现数字化扩展。
制定POCQI实施框架是该倡议在全国范围内成功实施的必要条件。实施计划应灵活适应医疗系统的需求、目标人群和实施机构的能力，并能接受多次迭代变化。
