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Amy Stern Amy Stern Presentation Transcript

  • Integrating M&E at the clinic level Amy F. SternUSAID HEALTH CARE IMPROVEMENT PROJECT (HCI) UNIVERSITY RESEARCH CO., LLC February 22, 2012 1
  • Data use at each level of health system. National Inform National planning Global Region/ Show District Impact of Facility Support, Programs coach & Identify & mentor address gaps in care USAID HEALTH CARE IMPROVEMENT PROJECT
  • Effective M&E integration at the clinic level: key lessons1. Use metrics relevant to the clinic – Denominators reflective of clinic patients2. Make data collection part of the daily routine – Document in clinic data collection tools.3. Use data to inform decisions to improve clinic performance – Monthly review and analysis; identify gaps in service delivery, test changes to improve performance and close the gap USAID HEALTH CARE IMPROVEMENT PROJECT
  • 1. Use metrics relevant to the clinic 4
  • Use clinic based denominator Output Indicator 1 The # and proportion of undernourished PLHIV that received therapeutic or supplementary food at any point during the reporting period Numerator: # of clinically undernourished PLHIV that received therapeutic or supplementary food Denominator: # of PLHIV nutritionally assesses & found to be clinically undernourished (who visited this facility) USAID HEALTH CARE IMPROVEMENT PROJECT
  • Feasible quality criteria by region Feasible Quality Criteria 100 90 80 70 60Percent 50 National Level 40 Facility Level 30 20 10 0 East Eurasia West Southeast Southern Africa * ++ Africa * Asia + Africa * USAID HEALTH CARE IMPROVEMENT PROJECT
  • The value of process indicators Process measures are more sensitive and more useful performance indicators than outcome measures when looking at a narrower perspective such as a clinic, department, hospital.1 1MantJ. 2001. Process versus outcome indicators in the assessment of quality of healthcare. Accessed on:23 Jan. 2012. Available at: http://intqhc.oxfordjournals.org/contents/13/6/475.full.pdf+html USAID HEALTH CARE IMPROVEMENT PROJECT
  • 2. Make data collection part ofthe daily routine 8
  • 3. Use data to makedecisions to improve clinicperformance 9
  • % of clients whose nutritional status is assessed using mid- upper arm circumference (MUAC) 100 90 80 70 Nutrition training 60 50% Delivery of 40 commodities 30 20 10 0 w11 w1 w3 w5 w7 w9 w-12 w-20 w-18 w-16 w-14 w-10 w-8 w-6 w-4 w-2 w21 w13 w15 w17 w19 w23 w25 w27 USAID HEALTH CARE IMPROVEMENT PROJECT
  • % of clients whose nutritional status is assessed using mid- upper arm circumference (MUAC) 100 90 80 70 Nutrition training 60 50% Delivery of 40 commodities 30 20 10 0 w11 w1 w3 w5 w7 w9 w-12 w-20 w-18 w-16 w-14 w-10 w-8 w-6 w-4 w-2 w21 w13 w15 w17 w19 w23 w25 w27 Tell everyone to do MUAC Assign a staff person to do Train expert clients to do a non-sustained change MUAC after registration MUAC A sustained change USAID HEALTH CARE IMPROVEMENT PROJECT
  • Develop changes to test• Where is the best place to assess?• Who should assess?• How can the findings be recorded?• How to link clients with treatment? USAID HEALTH CARE IMPROVEMENT PROJECT
  • Key results, Kenya: Change ideas tested to improve nutritional assessment of HIV patients1. Relocated place for nutritional assessment from clinician room to registration desk2. Re-assigned task of assessing nutritional status to expert patients3. Synchronized RUTF collection date with ARV follow-up dates4. Began collecting details of clients (home address, cell phone number, etc.) to help trace those who miss follow-up appointments5. Revised patient flow to enable easier movement of clients from one service area to another and to decrease waiting time6. Testing changes in other parts of facilities e.g. now at MNCH7. Successful lobbying for anthropometric equipment from partner organizations to enable nutritional assessments at the facility USAID HEALTH CARE IMPROVEMENT PROJECT
  • Key results, Kenya: Increasing nutritionalassessments for HIV infected patients Percentage of HIV Patients Assessed for Nutritional Status from Ambira Hospital in Kenya September through November 2011 100 80 60 40 Percentage 20 0 BASELINE WK1 WK2 WK3 WK4 WK1 SEP SEP SEP SEP OCT OCTWK2 WK3 WK4 WK1 OCT OCT NOV NOV-WK2 WK3 WK 4 NOV NOV # of HIV +VE clients assessed for Nutritional Status and categorize MAM 0 49 148 109 138 214 253 162 211 202 244 270 220 SAM,Normal,Obese Total # of HIV positive clients visiting the health facility 0 57 169 224 161 217 254 165 212 202 247 275 257 Clients Nutritionally assesed and categorized 0 85.96 87.57 93.3 85.71 98.6 99.6 98.2 99.5 100 98.7 98.1 85.6 Numerator: # of HIV infected clients assessed for nutritional status and categorized Denominator: Total # of HIV infected patients visiting the health facility that month Data Source/Sampling: HIV Register USAID HEALTH CARE IMPROVEMENT PROJECT
  • Best practices• Integrate assessment with existing registration or triage stations• Have expert clients help with the additional work load – Train enough expert clients to accommodate for when some are not available – Provide supervision/mentorship for expert clients• Document nutrition status in existing registry rather than creating a new document USAID HEALTH CARE IMPROVEMENT PROJECT
  • Effective M&E integration at the clinic level: key lessons1. Use metrics relevant to the clinic – Denominators reflective of clinic patients2. Make data collection part of the daily routine – Document in clinic data collection tools.3. Use data to inform decisions to improve clinic performance – Monthly review and analysis; identify gaps in service delivery, test changes to improve performance and close the gap USAID HEALTH CARE IMPROVEMENT PROJECT