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Putting Quality on the Global Health Agenda

Kirstin W. Scott, M.Phil., and Ashish K. Jha, M.D., M.P.H. Putting Quality on the Global Health Agenda. New England Journal of Medicine. NEJM 371;1 July 3, 2014
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'Although there is no single definition of high-quality care, the Institute of Medicine describes it as having six key features: it is safe, effective, patient-centered, efficient, timely, and equitable.'
'Patient safety - Iatrogenic harm is a major source of disability and death globally. For example, there are an estimated 23 million disability-adjusted life-years lost annually owing to harm from common inpatient adverse events. Examples include Rate of medication errors, hospital-acquiredinfections, foreign body left in body during surgical procedure.'
'Effectiveness - Providers often fail to provide basic evidence-based diagnosis or treatment to patients. For example, only 12% of children in India presenting with diarrhea received appropriate treatment. Rate of cervical-cancer screening, glycemic control for patients with diabetes, appropriate treatment for childhood diarrhea'
'In a study [*] involving standardized patients in India, nearly 7 in 10 medical providers failed to ascertain the basic pertinent history for common ailments such as angina, asthma, and childhood diarrhea and incorrectly diagnosed a large majority of cases... Consequently, their treatment advice was usually inappropriate, and for some conditions it was more often harmful than helpful (e.g., recommending anticholinergic medications for children with viral diarrhea).'
[Note from HIFA moderator: Das J, Holla A, Das V, Mohanan M, Tabak D, Chan B. In urban and rural India, a standardized patient study showed low levels of provider training and huge quality gaps. Health Aff (Millwood) 2012;31:2774-84. (This paper was previous highlighted on HIFA by James Hudspeth, USA: Two studies of note on provider knowledge in India, 20 February 2013  the abstract of the Das et al paper:
'This article reports on the quality of care delivered by private and public providers of primary health care services in rural and urban India. To measure quality, the study used standardized patients recruited from the local community and trained to present consistent cases of illness to providers. We found low overall levels of medical training among health care providers; in rural Madhya Pradesh, for example, 67 percent of health care providers who were sampled reported no medical qualifications at all. What's more, we found only small differences between trained and untrained doctors in such areas as adherence to clinical checklists. Correct diagnoses were rare, incorrect treatments were widely prescribed, and adherence to clinical checklists was higher in private than in public clinics. Our results suggest an urgent need to measure the quality of health care services systematically and to improve the quality of medical education and continuing education programs, among other policy changes.'
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