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Health care Health care quality Quality indicators Guideline Adherence Chronic diseases Diabetes Hypertension Epilepsy
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The Quality of Care Provided to Patients with Chronic Non-Communicable Diseases: A Retrospective Multi-Setup Study In Jimma Zone, Southwest Ethiopia
Abstract
BACKGROUND: Chronic Non-Communicable Diseases are among the major causes of morbidity and mortality worldwide. However, access to and quality of health care for patients is very low in developing countries including Ethiopia. Hospitals and Health Centers are the main sources of health care for such patients in Ethiopia. In this study we assessed the quality of care patients with Chronic Non-Communicable Diseases received in hospital and health center setups.
METHODS: A retrospective multi-setup study was conducted in Jimma University Specialized Hospital and four Health Centers in Jimma Zone from February to March 2010. A total of 52 process indicators of quality covering three disease conditions: Diabetes, Hypertension and Epilepsy were measured by reviewing randomly selected medical records. Quality of care was measured as a proportion of recommended components of care actually provided to patients. And also outcome and structural measures were assessed to supplement process measures of quality.
RESULTS: Six hundred seventy four medical records were reviewed. Recommended care components were actually provided to patients in 35.1% (95%CI:34.1%,36.0%), 38.5% (95%CI:37.5%,39.5%) and 60.1% (95%CI:59.3%,61.0%) of times on which patients were eligible, among patients with Diabetes, Hypertension and Epilepsy, respectively. After case mix adjustment, it was found that 45.9% (95%CI:45.4%,46.5%) of recommended components of care was actually provided to patients. This was 45.1% (95%CI:44.4%,45.8%) in the hospital and 30.5% (95%CI:29.7%,31.3%) in the health centers. Among patients for whom outcome data was available, optimal level of disease control was achieved only for 47 (30.5%), 40(38.5%) and 193 (52.9%) of patients with Diabetes, Hypertension and Epilepsy, respectively.
CONCLUSION: The quality of care provided to patients with Chronic Non-Communicable Diseases is very low in both settings though it is relatively better in Jimma University Specialized Hospital. Therefore, a continuous process of quality improvement is recommended in both settings.
KEYWORDS: Health care, Health care quality, Quality indicators, Guideline Adherence, Chronic diseases, Diabetes, Hypertension, Epilepsy
METHODS: A retrospective multi-setup study was conducted in Jimma University Specialized Hospital and four Health Centers in Jimma Zone from February to March 2010. A total of 52 process indicators of quality covering three disease conditions: Diabetes, Hypertension and Epilepsy were measured by reviewing randomly selected medical records. Quality of care was measured as a proportion of recommended components of care actually provided to patients. And also outcome and structural measures were assessed to supplement process measures of quality.
RESULTS: Six hundred seventy four medical records were reviewed. Recommended care components were actually provided to patients in 35.1% (95%CI:34.1%,36.0%), 38.5% (95%CI:37.5%,39.5%) and 60.1% (95%CI:59.3%,61.0%) of times on which patients were eligible, among patients with Diabetes, Hypertension and Epilepsy, respectively. After case mix adjustment, it was found that 45.9% (95%CI:45.4%,46.5%) of recommended components of care was actually provided to patients. This was 45.1% (95%CI:44.4%,45.8%) in the hospital and 30.5% (95%CI:29.7%,31.3%) in the health centers. Among patients for whom outcome data was available, optimal level of disease control was achieved only for 47 (30.5%), 40(38.5%) and 193 (52.9%) of patients with Diabetes, Hypertension and Epilepsy, respectively.
CONCLUSION: The quality of care provided to patients with Chronic Non-Communicable Diseases is very low in both settings though it is relatively better in Jimma University Specialized Hospital. Therefore, a continuous process of quality improvement is recommended in both settings.
KEYWORDS: Health care, Health care quality, Quality indicators, Guideline Adherence, Chronic diseases, Diabetes, Hypertension, Epilepsy
