andrea zin instituto fernandes figueira/fiocruz, rio de janeiro, brazil cbm medical advisor...
Post on 31-Dec-2015
214 Views
Preview:
TRANSCRIPT
Andrea Zin
Instituto Fernandes Figueira/FIOCRUZ, Rio de Janeiro, Brazil
CBM Medical Advisor
Childhood Blindness Subcomittee/ /IAPB LA
9 IAPB General Assembly, Hyderabad, India
Course 5: Data Collection and Information Management
Monitoring and Evaluating ROP Clinical and ProgrammeOutcomes in Latin America
DISCLOSURE STATEMENT
Nothing to disclose
Overview
• Need for monitoring and evaluation: ROP MIS• Data collection issues for ROP programmes• Strengths and limitations of current approaches,
and the potential for integration in health• How existing data can help decision making• Results based reports for stakeholders
Need for monitoring and evaluation: ROP MIS
• ROP blindness prevention in Latin America:
• ROP is the main cause of childhood blindness*
• ROP is an indicator of quality of neonatal care
• Magnitude:
• at least 42,000 babies BW < 1,500 to examine/year
• Over 4,000 treatments/year
• Multidisciplinary approach: nurses, neonatologists,
ophthalmologists
• Multilevel prevention approach: primary, secondary and
tertiary
* Gilbert C. Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control. Early Hum Dev. 2008;84(2):77– 82
Need for monitoring and evaluation: ROP MIS• ROP blindness prevention in Latin America:
• Several countries in the region now have policies and/or
regulations, leading to financing structures for examination or
for laser treatment: ROP programme implementation
• Quality control is needed at different levels: neonatal care, eye care, programme
• Challenge: lack of MIS for quality control•coverage, detection, population needing treatment, treatment rates and results
•NICU, district, country/regional level
Data collection issues for ROP programmes• Lack of standard data collection forms in several ROP
programmes• Decision: data to be collected (accurate, precise, valid,
timeliness, unbiased, relevant)• Indicators: clinical outcomes, programme outcomes• GIGO: garbage in = garbage out
• Lack of dedicated trained personnel for data management: nurse, nurse technician?• Data entry• Quality control• Data security• Data storage• Data management: cleaning, descriptive analysis,
associations
• Neonatal outcome data: networking with nurses and neonatologists (some countries - neonatal networks)
Strengths and limitations of current approaches, and the potential for
integration in health• Web based ROP Network (PAAO/PAHO/cbm SiB):
www.redeneonatal.fiocruz.br/rop
• Standardised data collection forms
Strengths and limitations of current approaches, and the potential for
integration in health
Strengths and limitations of current approaches, and the potential for
integration in health• Web based ROP Network (PAAO/PAHO/cbm SiB):
www.redeneonatal.fiocruz.br/rop
• Diary system: avoid missing exams
• Reports readily available, customized according to
needs
• Different levels of access: quality and security
• Integration with Brazilian Neonatal Network
• Neonatal outcome indicators
• Monitoring and evaluation
Report
Strengths and limitations of current approaches, and the potential for
integration in health 2009
Unidade Elegíveis*Total de exames
% exame
A 39 39 100%
B 207 177 86%
C 53 48 91%
D 27 20 74%
E 75 69 92%
F 67 52 78%
G 78 65 83%
H 51 45 88%
I 64 57 89%
J 41 34 83%
K 53 52 98%
L 60 50 83%
M 62 57 92%
N 36 32 89%
O 33 27 82%
P 47 45 96%Total
Global 993 869 88%
* Excluídos os óbitos
2010
Unidade Elegíveis*Total
exames % exame
A 37 33 89%
B 180 141 78%
C 57 55 96%
D 27 22 81%
E 82 75 91%
F 53 35 66%
G 69 55 80%
H 47 42 89%
I 60 54 90%
J 32 31 97%
K 83 81 98%
L 49 47 96%
M 59 54 92%
N 44 39 89%
O 26 25 96%
P 50 45 90%Total 955 834 87%
* Excluídos os óbitos
2011
Unidade Elegíveis* Total de exames % exames
A 41 41 100%
B 204 183 90%
C 50 45 90%
D 45 37 82%
E 72 68 94%
F 51 39 76%
G 77 69 90%
H 54 53 98%
I 71 67 94%
J 24 24 100%
K 59 57 97%
L 59 51 86%
M 56 52 93%
N 21 19 90%
O 32 28 88%
P 47 37 79%Total 963 870 90%
* Excluídos os óbitos
Strengths and limitations of current approaches, and the potential for
integration in health2009
UnidadeTotal
ExaminadosTotal
Tratados% ROP Tratada
A 39 3 8%
B 177 12 7%
C 48 2 4%
D 20 4 20%
E 69 3 4%
F 52 2 4%
G 65 4 6%
H 45 2 4%
I 57 4 7%
J 34 0 0%
K 52 3 6%
L 50 2 4%
M 57 8 14%
N 32 0 0%
O 27 1 4%
P 45 7 16%
Total 869 57 7%
2010
UnidadeTotal
ExaminadosTotal
Tratados% ROP Tratada
A 33 1 3%
B 141 4 3%
C 55 7 13%
D 22 2 9%
E 75 4 5%
F 35 1 3%
G 55 2 4%
H 42 3 7%
I 54 1 2%
J 31 1 3%
K 81 4 5%
L 47 1 2%
M 54 4 7%
N 39 0 0%
O 25 1 4%
P 45 0 0%
Total 834 36 4%
2011
UnidadeTotal
Examinados
Total Tratado
s
% ROP Tratada
A 41 0 0%
B 183 5 3%
C 45 4 9%
D 37 0 0%
E 68 3 4%
F 39 4 10%
G 69 0 0%
H 53 1 2%
I 67 2 3%
J 24 1 4%
K 57 0 0%
L 51 4 8%
M 52 4 8%
N 19 0 0%
O 28 1 4%
P 37 0 0%
Total 870 29 3%
Strengths and limitations of current approaches, and the potential for
integration in health2009-2011
Strengths and limitations of current approaches, and the potential for
integration in health• Web based ROP Network (PAAO/PAHO/cbm SiB):
www.redeneonatal.fiocruz.br/rop
• Web based: maintenance, access
• Dedicated, trained personnel
• Cost, sustainability
• Opportunity: integration in health system
How existing data can help decision making
• Coverage
• Level of care: neonatal indicators
• survival, surfactant, sepsis, BPD
• Screening criteria: BW and GA of treated babies
• Quality of detection
• Treatment results
Results-based reports for stakeholders
Results-based reports for stakeholders
Mongolia
Caracas, Venezuela
Lima, Peru
India
Havana, Cuba
Coimbature, India
Guayaquil, Ecuador
Guadalaraja, Mexico
Cali, ColombiaSalvador, Brasil
top related