quality improvement applied science assist project
TRANSCRIPT
![Page 1: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/1.jpg)
USAID Applying Science to Strengthen and Improve Systems1
Quality Improvement –Applied Science: Experience from 6 States in India
Neerja Arora MBBS DFM DHHS MBAState Improvement Coordinator, NCT of Delhi
USAID ASSIST Project
![Page 2: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/2.jpg)
USAID Applying Science to Strengthen and Improve Systems
At what scale are we working in India?
263 facilities
MOHFW
263 QI teams
12-14,000 deliveries per month
30% of deliveries in 27 High Priority Districts
![Page 3: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/3.jpg)
USAID Applying Science to Strengthen and Improve Systems
263 teams are working to improve RMNCH+A services:
Most teams:• Antenatal care • Intra-partum care• Immediate postpartum care • Essential newborn care Some teams:- Neonatal resuscitation - Identification and management of anemia- Identification and management of pregnancy
associated hypertension- Diarrhea management in children- ARSH clinics 3
![Page 4: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/4.jpg)
USAID Applying Science to Strengthen and Improve Systems4
Results
![Page 5: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/5.jpg)
USAID Applying Science to Strengthen and Improve Systems
Improving Antenatal Care in Zonal Hospital, Mandi in Himachal Pradesh
5
![Page 6: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/6.jpg)
USAID Applying Science to Strengthen and Improve Systems
Antenatal care in Mandi, Himachal Pradesh
6
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-5
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-5
W-1
W-2
W-3
W-1
W-2
Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14
020406080
100Denominator: Number of ANCs conducted per week in Mandi, Himachal Pradesh (average = 45.6)
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-5
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-5
W-1
W-2
W-3
W-1
W-2
Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14
0%10%20%30%40%50%60%70%80%90%
100%
Percentage of ANCs during which BP and Hb were measured in Mandi, Himachal Pradesh, July 2013-March 2014
% BP measured
% Hb measured
![Page 7: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/7.jpg)
USAID Applying Science to Strengthen and Improve Systems
Antenatal care in Mandi, Himachal Pradesh
7
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-5
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-5
W-1
W-2
W-3
W-1
W-2
Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
2
4
6
8
10
12
Number of high-risk pregnancies identified and percentage of ANCs during which BP and Hb were measured in Mandi, Himachel Pradesh
# high-risk identified % BP measured % Hb measured
18 high-risk pregnancies identified (1.4%)
39 high-risk pregnancies identified (12.3%)
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-5
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-5
W-1
W-2
W-3
W-1
W-2
Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
2
4
6
8
10
12
Number of high-risk pregnancies identified and percentage of ANCs during which BP and Hb were measured in Mandi, Himachel Pradesh
# high-risk identified % BP measured % Hb measured
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-5
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-1
W-2
W-3
W-4
W-5
W-1
W-2
W-3
W-1
W-2
Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
2
4
6
8
10
12
# high-risk identified % BP measured % Hb measured
![Page 8: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/8.jpg)
USAID Applying Science to Strengthen and Improve Systems
Improving Delivery Care in District Women’s Hospital, Pauri in
Uttarakhand
8
![Page 9: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/9.jpg)
USAID Applying Science to Strengthen and Improve Systems
Change in management of delivery cases on the basis of partographs, at District Women’s Hospital, Pauri in Uttarakhand
July-September 2014
9
0
20
40
60
80
100
120
140
160
180
200184
145
35
21
4
Management changed for 21 cases on the basis of partographs
Maternal Hypertension- 6 casesMaternal Hypotension- 4 casesAltered Fetal Heart Rate- 4 casesMeconium stained liquor- 5 cases
Timely referral of 4 cases
Cases referred with duly filled partographsNo patient delivered in the ambulance!
![Page 10: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/10.jpg)
USAID Applying Science to Strengthen and Improve Systems
Improving Post-partum Care in Bhagwan Mahavir HospitalNorth-West district in Delhi
10
![Page 11: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/11.jpg)
USAID Applying Science to Strengthen and Improve Systems11
Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-140
1
2
3
4
5
6
7
8
9
0
5
10
15
20
25
30
35
40
0 02
0 0 0
5
14
1113
2.4 2.6
6 6.26.5
77.5
8
7.2 7
Improving Postpartum Monitoring for early detection of complications to reduce maternal mortality-
Bhagwan Mahavir Hospital, Delhi
Number of postpartum women identified with postpartum danger signsAverage number of documented postpartum monitorings
BaselineImproving early pick-up of complications under new system of careObservation roomPartnering with patients’ attendants
Improving the frequency of monitoringInvolvement of doctors & nursesSharing of work between Labor room & PP wardUse of opportunity for care
![Page 12: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/12.jpg)
USAID Applying Science to Strengthen and Improve Systems
Major Indicators: All StatesImproving routine care of mothers and babies
Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-140%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
12-14,000 deliveries per month30% of deliveries in the High Priority DistrictsMothers who received In-
jection Oxytocin 10IU I/M for AMTSL
Newborns given injection Vitamin K
Women whose Hemoglobin was checked during ANC
Newborns Breastfed within one hour of birth
![Page 13: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/13.jpg)
USAID Applying Science to Strengthen and Improve Systems13
How these results were obtained
![Page 14: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/14.jpg)
USAID Applying Science to Strengthen and Improve Systems
6 steps to improve care
1. Defining the improvement aim
2. Forming the improvement team
3. Understanding the current system
4. Developing a measurement system• Developing indicators • Plotting a time-series
chart 5. Developing changes6. Testing and implementing
changes
![Page 15: Quality improvement applied science assist project](https://reader038.vdocument.in/reader038/viewer/2022110108/58efb0ce1a28ab3b488b463b/html5/thumbnails/15.jpg)
USAID Applying Science to Strengthen and Improve Systems15
JK
UK
DL
JK
Thanks