Division of Prevention Science, Department of Medicine, University of California, San Francisco, California, USA.
Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.
Trop Med Int Health. 2022 Jan;27(1):68-80. doi: 10.1111/tmi.13701. Epub 2021 Dec 16.
High-quality healthcare is essential to ensuring maternal and newborn survival. Efficient measurement requires knowing how long measures of quality provide consistent insight for intended uses.
We used a repeated health facility assessment in Senegal to calculate structural and process quality of antenatal care (ANC), delivery and child health services in facilities assessed 2 years apart. We tested agreement of quality measures within facilities and regions. We estimated how much input-adjusted and process quality-adjusted coverage measures changed for each service when calculated using quality measurements from the same facilities measured 2 years apart.
Over 6 waves of continuous surveys, 628 paired assessments were completed. Changes at the facility level were substantial and often positive, but inconsistent. Structural quality measures were moderately correlated (0.40-0.69) within facilities over time, more so in hospitals; correlation was <0.20 for process measures based on direct observation of ANC and child visits. Most measures were more strongly correlated once averaged to regions; process quality of child services was not (-0.32). Median relative difference in national-adjusted coverage estimates was 6.0%; differences in subnational estimates were largest for process quality of child services (19.6%).
Continuous measures of structural quality demonstrated consistency at regional levels and in higher level facilities over 2 years; results for process measures were mixed. Direct observation of child visits provided inconsistent measures over time. For other measures, linking population data with health facility assessments from up to 2 years prior is likely to introduce modest measurement error in adjusted coverage estimates.
高质量的医疗保健对于确保母婴生存至关重要。高效的衡量标准需要知道衡量标准在预期用途方面能提供一致的见解需要多长时间。
我们在塞内加尔使用了一项重复的卫生机构评估，以计算相隔两年评估的卫生机构中产前护理（ANC）、分娩和儿童健康服务的结构和过程质量。我们测试了卫生机构和地区内质量措施的一致性。我们估计了在使用相隔两年的相同卫生机构的质量测量值计算时，每种服务的投入调整和过程质量调整覆盖范围指标会发生多少变化。
在连续六波调查中，完成了 628 对配对评估。设施层面的变化很大，而且往往是积极的，但不一致。结构质量措施在时间上在设施内呈中度相关（0.40-0.69），在医院中更为相关；基于 ANC 和儿童就诊直接观察的过程措施的相关性<0.20。大多数措施在平均到地区后相关性更强；基于儿童服务的过程质量相关性不强（-0.32）。全国调整后覆盖范围估计的中位数相对差异为 6.0%；在儿童服务过程质量方面，次国家估计的差异最大（19.6%）。
在 2 年内，结构质量的连续衡量标准在区域水平和更高水平的设施中表现出一致性；过程衡量标准的结果好坏参半。随着时间的推移，对儿童就诊的直接观察提供了不一致的衡量标准。对于其他措施，将人口数据与长达 2 年前的卫生机构评估联系起来，可能会在调整后的覆盖范围估计中引入适度的测量误差。
