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Evaluation and cost-effectiveness analysis of a quality improvement collaborative approach for the testing and management of eclampsia /pre-eclampsia cases in Mali
Research & Evaluation Study Profiles
Organization:
USAID Health Care Improvment Project/URC
Topics: Maternal, Newborn and Child Health, Pre-eclampsia/eclampsia
Region and Country: Africa, Sub Saharan, Mali
Year:
2011
Language:
English Description:
An evaluation of the USAID Healthcare Improvement (HCI) Project summarizing the results of collaborative improvement in 12 countries by over 1300 teams during 1998-2008 has shown that teams were able to achieve large increases in compliance with health care standards and in some cases, in health outcomes, across all care areas addressed, regardless of the baseline level of quality (Franco 2009). Several other reports also demonstrate the cost-effectiveness of collaborative quality improvement in achieving high compliance to standards of care and in improving outcomes. However, due to operational restrictions, most assessments of quality improvement collaboratives (QICs) have been uncontrolled pretest–post-test designs that cannot rule out other plausible causes for observed improvements, such as secular trends (Mittman 2004).
This study will address this issue by comparing costs and outcomes for clinical management of eclampsia and pre-eclampsia in quality improvement collaborative facilities to facilities with no collaborative improvement intervention in the first six months. Following the initial six months, the collaborative improvement methodology will be introduced to the control sites and changes in quality performance will be monitored over that time.
Implementation by the HCI Project of interventions to improve maternal and newborn health services including AMSTL and essential newborn care has been ongoing in 41 facilities in two health districts (Diema and Kayes) in the Kayes region since early 2010. Most facilities are above 80% compliance in active management of the third stage labor (AMSTL) and essential and newborn care (ENC) quality indicators and are currently working on maintaining or improving performance.
The HCI Mali / Niger team started implementing a second QIC phase aimed at improving clinical practice with regard to pre-eclampsia and eclampsia care at the end of February, 2011. This study will determine the costs and effects of this QIC intervention and compare them to the costs and effects of a basic clinical training (BCT) in the same type of health facilities in Mali that are not part of the collaborative.
Research questions/objectives:
This study will determine whether a QIC intervention has an added value in improving pre-eclampsia and eclampsia care quality above basic clinical training (BCT) alone. It will also measure the relative efficiency of the two interventions. The specific research questions are:
- 1. Do pregnant and delivering women in QIC intervention facilities receive better care (screening/diagnostic and treatment of pre-eclampsia/eclampsia) than those in BCT-only facilities?
- 2. Do pregnant and delivering women in QIC intervention facilities have better clinical outcomes, in terms of eclampsia incidence than those in BCT-only facilities?
- 3. What is the incremental cost-effectiveness of the QIC intervention compared to the BCT-only intervention in terms of process and outcome indicators for mothers?
- 4. Does adherence to eclampsia/pre-eclampsia norms become higher in BCT-only sites when clinicians are trained on the QIC methodology?
- 5. Does adherence to eclampsia/pre-eclampsia norms in the QIC intervention facilities change in the six months following the active intervention period?
Methodology:
This longitudinal study uses a controlled pre- and post-intervention design. The QIC sites will be those participating in the QIC intervention and the control sites will receive BCT only. BCT is also part of the QIC intervention.
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