Using a quality improvement tool, Plan-Do-Study-Act cycle, to boost TB notification in India post-Covid-19 pandemic

Area of Science:

• Public Health
• Healthcare Quality Improvement
• Infectious Disease Control

Background:

• Quality improvement tools are crucial for enhancing healthcare delivery in India.
• The electronic-Plan-Do-Study-Act (e-PDSA) tool, developed by CETI, was previously piloted successfully.
• Scaling up the e-PDSA tool aimed to improve tuberculosis notification rates.

Purpose of the Study:

• To assess the feasibility, effectiveness, and cost-efficiency of a nationwide scale-up of the e-PDSA tool.
• To train District Tuberculosis Officers (DTOs) virtually to boost TB notification rates.
• To evaluate the impact of the e-PDSA intervention on TB notification post-COVID-19 pandemic.

Main Methods:

• A 10-week virtual training program on the e-PDSA cycle was offered to DTOs nationwide from May to July 2022.
• Quality improvement counselors served as liaisons to assist DTOs in completing the PDSA cycle.
• TB notification data from February-April 2022 (baseline) and May-July 2022 (intervention) were compared between PDSA and non-PDSA groups.

Main Results:

• Out of 779 districts, 546 DTOs (70%) enrolled, and 437 (80%) completed a PDSA cycle.
• Districts in the PDSA group showed a 55% improvement in TB notification compared to 45% in the non-PDSA group.
• The intervention cost $40,000 ($92 per DTO), with DTOs rating the course 4.3/5 for recommendation.

Conclusions:

• Large-scale implementation of the e-PDSA cycle is feasible, economical, and effective for improving TB notification.
• The intervention demonstrated a positive impact on TB notification rates, particularly in the PDSA group.
• Further PDSA cycles incorporating notification and other measures can significantly contribute to achieving a TB-Free India.