acasest da case study: leveraging m/ehealth to help ... · acasest da case study: leveraging...
Post on 24-Jun-2020
1 Views
Preview:
TRANSCRIPT
Bridging the Gaps January 31, 2014
1
A Case St dA Case Study: Leveraging m/eHealth to Help Improve Care
for Women with Eclampsia and Their Pre-term Newborns in Zaza District
1
Kathleen Hill, M.D., M.P.H.
Deputy Director, USAID ASSIST Project
University Research Co., LLC
The Case of Mariama and Boubacar: Zaza District
2
Bridging the Gaps January 31, 2014
2
At the Lava Clinic
• Mariama presented to the Lava Clinic 35 weeks pregnant with her first baby complaining of severe headacheheadache.
• Her blood pressure was elevated at174/110; the health post was out of urine dipsticks.
• The nurse asked Mariama and her husband to find transportation to the nearest hospital as soon as
iblpossible.
• Mariama and her husband decided to go the next morning once they could borrow money and arrange transportation.
3
At the Hospital
• The next morning on the way to the hospital Mariama suffered a seizure
• Once at the hospital they were told to wait in a long queue• Once at the hospital they were told to wait in a long queue
• 10 hours later Mariama was admitted to hospital and Magnesium Sulfate treatment was started for eclampsia
• The following morning Mariama delivered a small baby son who never started breathing; a neonatal bag and mask could not be found in the delivery room
M i d h h b d d th i d d b b• Mariama and her husband named their deceased baby son Boubacar
• A subsequent review of Mariama’s antenatal record during a death audit revealed that Mariama’s BP had been elevated on 2 prior ANC visits4
Bridging the Gaps January 31, 2014
3
Critical Quality & System Gaps for Mariama and Boubacar
Clinic:• Failure to detect and act on Mariama’s elevated blood pressure at prior
ANC visits (pre-eclampisa red flag)• No urine dipstick in clinic (diagnosis pre-eclampsia)
Linkages between Clinic and Hospital: • Failure of communication and timely transport between clinic & hospital• Nurse didn’t know who to contact (although she had a cell phone)
Hospital: D l d it (3 d d l ) d l k f t i t h it l
5
• Delayed wait (3rd delay) and lack of triage at hospital• Lack of timely administration Magnesium Sulfate (treatment eclampsia)
and corticosteroids (maturation lung in pre-term fetus)• Lack of timely resuscitation Boubacar (no resuscitation bag & mask)
What is the Problem?
“The reality is straightforward The power ofThe reality is straightforward. The power of existing interventions is not matched by the power of health systems to deliver them to those in greatest need, in a comprehensive way, and at an adequate scale.”
—Margaret ChanMargaret Chan
Director General
World Health Organization
6
Bridging the Gaps January 31, 2014
4
• Effectiveness of Care (adherence with best practices)
• Safety of Care (“do no harm”)
The Issue of Quality in Health Care
Safety of Care ( do no harm )
• Client-centeredness of Care (“respectful care”)
• Coordination of Care across system levels and life-cycle phases (“fragmentation of care”)
• Timeliness of Care
C t ff ti ( l )• Cost-effectiveness (value)
• Equity of Care (same quality for everyone)
“Every system is perfectly designed to achieve exactly the results it achieves” (Bataldan)Institute of Medicine 2001
Crossing the Implementation Divide to Improve Care
Understanding health care in terms of processes and systems
Team-work (all relevant actors, all system levels)
Regular use of data for action
Focus on patient needs
(client-centered)
88
Bridging the Gaps January 31, 2014
5
Conceptualizing Quality(Source: Donabedian)
9
What m/eHealth technologies might have helped Mariama and Boubacar if integrated into an improvement effort?
INPUTS PROCESSES RESULTS
Mobile phone communication between nurse and hospital
e-referral protocol and SMS messaging
i t d t i
Mariama’s elevated BP detected early
Prompt transfer to hospital with loading dose MgS04 & ACS in clinic
EMR w/automatic alert for elevated BP
EMR Integrated eClinical decision support tool to guide clinic nurse
10
e-assisted triage process at hospital Resuscitation and
survival of Boubacar
MgSO4, ACS & Bag&Mask available bedside
10
Bridging the Gaps January 31, 2014
6
Every Newborn Action Plan: Delivering integrated MNH packages at critical leverage points along the MNH continuum (Bernadette Daelmans, WHO)
11
One year later in Zaza District:District Management Team Takes Action
12
Bridging the Gaps January 31, 2014
7
Key District Team Actions
• Improvement team created & actively supported in every facility including: – Competency based training/supervision coupled with on-siteCompetency based training/supervision coupled with on site
e-clinical decision support
– Team support to test changes to improve care processes (e.g., e-automated triage in hospital)
– Mobile phones with emergency contact #s
• Supply chain e-tools adopted all levels to ensure essential commodities at the bedside (MgSO4 ACS bag & mask)commodities at the bedside (MgSO4, ACS, bag & mask)
• Facility teams supported to document and analyze common monthly quality and outcome measures using automated run charts generated by EMR
• Quarterly district meetings to assess progress & share learning
13
Competency Based Newborn Resuscitation Training and Peer to Peer Observation
(could use an e-checklist…)
14
Bridging the Gaps January 31, 2014
8
Percentage of pre-eclampsia and eclampsia case management standards achieved
Jan-Dec 2008, average of 120 cases analyzed per monthBased on detection in 120,000 patient contacts at 31 MOH facilities
Measuring Adherence withPre-eclampsia/eclampsia Best Practices to Improve
PE/E Care in Niger 31 facilities
40%
50%
60%
70%
80%
90%
Changes implemented:•Systematic screening at every contact•Organization daily tasks to prevent
0%
10%
20%
30%
40%
J08 F08 M08 A08 M08 J08 J08 A08 S08 O08 N08 D0815
•Organization daily tasks to prevent stock outs•Standardized emergency case management eclampsia•Standardized referral protocols
15
Hospital Improvement Team
16
Bridging the Gaps January 31, 2014
9
Accelerating Progress through Shared Learning…..Tracking Automated Results Across Facilities for Collective Action
What changes are robust and effective Learningrobust and effective across teams?
Collaborative coachor manager
Site-level summaryQI team
LearningSession
representative
Which changes really yield improvements?
1717
Moving beyond building blocks to grow dynamic systems that strategically integrate
m/eHealth technologies
18
Bridging the Gaps January 31, 2014
10
19
Thank You
20
top related