A nationwide program to improve clinical care quality in the Kyrgyz Republic

To assess baseline quality of care in the Kyrgyz Republic in 2019 and determine the effect of online simulated patients in changing doctors' practice in three specific disease areas: non-communicable disease, neonatal/child health, and maternal health. Over 2000 family health, pediatric, neonat...

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Published in:	Journal of global health Vol. 10; no. 2; p. 020418
Main Authors:	Peabody, John W, Oskombaeva, Klara, Shimarova, Memerian, Adylbaeva, Venera, Dzhorupbekova, Kanzaada, Sverdlova, Irina, Shukurova, Venera, Abdubalieva, Zhyldyz, Gagloeva, Natalya, Kudayarova, Ainura, Mukanbetovna, Aizhamal Asanbekova, Dzhumagazievna, Nurgul Shoonaeva, Vibornykh, Violetta, Zhorobekovna, Mimoza Satybaldieva, de Belen, Enrico, Paculdo, David, Tamondong-Lachica, Diana, Novinson, Daniel, Valdenor, Czarlota, Fritsche, Gyorgy
Format:	Journal Article
Language:	English
Published:	Scotland Edinburgh University Global Health Society 01-12-2020 International Society of Global Health
Subjects:	Child Childrens health Clinical medicine Disease Epidemiology Feedback Female Global health Health care policy Hospitals Humans Infant Health Infant, Newborn Kyrgyzstan Male Maternal Health Maternal mortality Medical personnel Noncommunicable Diseases Pediatrics Physicians Pregnancy Quality Improvement Quality of Health Care Sepsis Kyrgyzstan Asia Europe
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Summary:	To assess baseline quality of care in the Kyrgyz Republic in 2019 and determine the effect of online simulated patients in changing doctors' practice in three specific disease areas: non-communicable disease, neonatal/child health, and maternal health. Over 2000 family health, pediatric, neonatology, therapy, and obstetric-gynecologic doctors from every rayon (district) hospital and at least one associated family health (Primary) care clinic participated. To adequately scale the project, the Ministry of Health used online simulated Clinical Performance and Value (CPV) vignettes. All doctors cared for the same set of patients in their clinical area. Over eight months in 2019, we gathered three rounds of CPV data in seven oblasts. Overall quality scores were highly variable at baseline (59.2% + 13.5%). After three rounds the average score increased 6.5% ( < 0.001). By the end of round three, the lowest scoring oblast was providing higher quality care compared to the highest scoring oblast in the initial round (64.2% in round 3 vs 62.4% in round 1), indicating greater adherence to the evidence base. Additionally, family health doctors ordered 26% fewer unnecessary tests ( < 0.05), while specialists ordered 39% fewer unnecessary tests ( < 0.05). If trends continue, this translates into a net annual savings of 63 million Kyrgyz som. This study demonstrates serial measurement of care provided by over 2000 physicians in the Kyrgyz Republic can be improved as measured by CPVs. This project may be a useful template to improve health care quality at a national level in other low- and middle-income country settings.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2047-2978 2047-2986 2047-2986
DOI:	10.7189/jogh.10.020418