TY - JOUR T1 - Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan. JF - Bull World Health Organ Y1 - 2017 A1 - Lazzerini, Marzia A1 - Shukurova, Venera A1 - Davletbaeva, Marina A1 - Monolbaev, Kubanychbek A1 - Kulichenko, Tatiana A1 - Akoev, Yuri A1 - Bakradze, Maya A1 - Margieva, Tea A1 - Mityushino, Ilya A1 - Namazova-Baranova, Leyla A1 - Boronbayeva, Elnura A1 - Kuttumuratova, Aigul A1 - Weber, Martin Willy A1 - Tamburlini, Giorgio KW - Child KW - Child Care KW - Cluster Analysis KW - Hospitalization KW - Hospitals, Public KW - Humans KW - Kyrgyzstan KW - Medical Audit KW - Pediatricians KW - Professional Role KW - Prospective Studies KW - Quality Improvement AB -

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 ( < 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.

VL - 95 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28603306?dopt=Abstract ER -