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Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan
Marzia Lazzerini1, Venera Shukurova2, Marina Davletbaeva3
1World Health Organization Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell'Istria 65/1, Trieste, 34137, Italy.
Insights
Periodic supportive supervision significantly improved paediatric hospital care quality in Kyrgyzstan. This intervention, following a training course, led to better adherence to World Health Organization guidelines and reduced inappropriate care for children.
Area of Science:
- Pediatric Healthcare Quality Improvement
- International Public Health Interventions
- Clinical Practice Guidelines Adherence
Background:
- Inappropriate paediatric care was prevalent in Kyrgyzstan, despite low in-hospital postnatal mortality.
- Effective strategies were needed to enhance the quality of hospital care for children.
Purpose of the Study:
- To evaluate the impact of periodic supportive supervision on paediatric hospital care quality.
- To assess adherence to World Health Organization (WHO) guidelines for child hospital care.
Main Methods:
- A cluster-randomized trial involving 20 public hospitals in Kyrgyzstan.
- Intervention group received a WHO training course followed by 1 year of supportive supervision.
- Control group received no intervention; 10 key indicators of inappropriate care were assessed.
Main Results:
- The primary indicator of inappropriate care significantly decreased in the intervention group (46.9% to 6.8%).
- The risk ratio for the primary indicator was 0.09 (95% CI: 0.06 to 0.13) in favor of the intervention group.
- All nine other indicators of inappropriate care also improved, alongside overall quality of care.
Conclusions:
- Periodic supportive supervision effectively enhances adherence to WHO guidelines for paediatric hospital care.
- The intervention demonstrated a significant improvement in the overall quality of paediatric care in Kyrgyzstan.
Objective:
To determine whether periodic supportive supervision after a training course improved the quality of paediatric hospital care in Kyrgyzstan, where inappropriate care was common but in-hospital postnatal mortality was low.
Methods:
In a cluster, randomized, parallel-group trial, 10 public hospitals were allocated to a 4-day World Health Organization (WHO) course on hospital care for children followed by periodic supportive supervision by paediatricians for 1 year, while 10 hospitals had no intervention. We assessed prospectively 10 key indicators of inappropriate paediatric case management, as indicated by WHO guidelines. The primary indicator was the combination of the three indicators: unnecessary hospitalization, increased iatrogenic risk and unnecessary painful procedures. An independent team evaluated the overall quality of care.
Findings:
We prospectively reviewed the medical records of 4626 hospitalized children aged 2 to 60 months. In the intervention hospitals, the mean proportion of the primary indicator decreased from 46.9% (95% confidence interval, CI: 24.2 to 68.9) at baseline to 6.8% (95% CI: 1.1 to 12.1) at 1 year, but was unchanged in the control group (45.5%, 95% CI: 25.2 to 67.9, to 64.7%, 95% CI: 43.3 to 86.1). At 1 year, the risk ratio for the primary indicator in the intervention versus the control group was 0.09 (95% CI: 0.06 to 0.13). The proportions of the other nine indicators also decreased in the intervention group (P < 0.0001 for all). Overall quality of care improved significantly in intervention hospitals.
Conclusion:
Periodic supportive supervision for 1 year after a training course improved both adherence to WHO guidelines on hospital care for children and the overall quality of paediatric care.
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