Use of SOC data by ICAP-Ethiopia for quality

improvement

Tsigereda Gadisa MD,MPH M&E Director, ICAP-Ethiopia

July, 2010

Using data for program improvement

Three key interlinked factors affecting data use1.Effective Reports compilation; relevance, validity,

completeness, timeliness, simplicity & big picture demonstration

2.Skilled Managers; result oriented, curios and good data use aptitude and committed in building result orient management culture

3.Organizational culture for evidence based learning and improvement; setting simple but informative performance measures & creating regular forum to follow though the results

Results Oriented Culture • Reward and recognize

• Encourage learning

• Seek involvement

• Use data routinely

• Lead improvement efforts

• Take responsibility

• Stimulate positive action

Site

Sta

rt-u

p Assess and improve implementation Site

support

team

Onsite teamAssess and

improve quality

Assess and Build

Capacity

Site

Ind

epen

denc

e

Goal 1: Implement a chronic care model of HIV care and treatment (comprehensive, family focused)

Goal 2: Build capacity to promote program sustainability and independence

ICAP Standards of Care

Define standards of care (SOCs) and measures of quality

Measure Standards of

Care

Identify Problems

Prioritize problem areas

Design and implement

intervention

SOC Data use for quality improvement Cycle

SOC Indicator setting and data compilation in ICAP Ethiopia

• With the TA from ICAP NY clinical team ICAP-E

clinical Service department adopted the Care and

treatment (adult and Ped); PMTCT, and TB HIV SOC

• Indicators were modified to our context

• Manual data collection instrument and SOP drafted

• The instruments were pilot tested in one regional

office for feasibility and user friendliness

Lesson learned during pilot testing the SOC instrument

– The process was cumbersome and time consuming; it required

• Manual tally and compile the tally• Entering the compiled data in to excel sheet• Make the calculation for each indicator• Compile the report and• Provide feed back to site provider by next visit

Action taken to make the instrument user friendly and provide immediate

feed back– Clinical service and M&E department discussed

to automate SOC data collection instrument

– SOC database developed for the five SOC instrument in use (adult C&T, Ped C&T, HEI, PMTCT and TB HIV)

Major objectives of SOC database

• Reduce work load on the site support team in data compilation

• Facilitate the data capturing and analysis– No manual tallying

• Facilitate instant feedback to the site staff on strength and areas for improvement

• Facilitate easily follow up of action points

Standard of Care Database (SOC

DB)

Measure Standards of

Care

Routine Report

Data quality

SOC

SOC Data use for quality improvement matrix

PMTCTC &T HCT TB/HIV

Simple countGross performance

More closer look in to Service qualityAsk why?

More closer look in to data qualityAsk why?

Common Data Source for SOC, Data Quality Assessment & Routine report

ARV Prophylaxis, at ANC PMTCT SOC VS routine report at Selected ICAP-Ethiopia

supported sites; Dec-9 toApril-10

Summary follow –Up PSOC assessment as compared to the baseline for HIV infected children in 8 ICAP supported Hospitals

Site Proportion of HIV+ children with accurately plotted growth measurements

Proportion of HIV+ children accurately documented neurodevelopment assessment in past 6 months

Proportion of HIV+-children who have CD4 done in the past 6 months

Proportion of HIV+ children who have had 2 clinical encounters in the past 6 months

Proportion of HIV+ children eligible for who are on HAART based on CD4 and/or clinical criteria

Proportion of HIV+ children on HAART with appropriate ARV dose prescribed

Baseline Follow-up Baseline

Follow-up Baseline

Follow-up Baseline Follow-up Baseline Follow-up Baseline

Follow-up

Dilchora 95 100 70 100 70 67 100 100 95 100 0 100Hiwot fana 29 69 0 100 57 69 100 100 100 100 50 69Chiro 40 54 0 75 60 75 100 82 100 94 0 13Karamara 23 83 0 100 72 50 100 100 100 100 0 67Jugol 0 25 89 100 22 50 89 100 100 100 100 88

Ambo 8 54 29 68 64 71 100 76 100 93 8 15Fitche 12 80 0 97 78 78 100 92 84 84 0 93Metehara 20 27 43 60 82 50 100 87 100 100 23 100

TB Screening among newly enrolled in care, Ginbot,01 (May-09) and Ginbot,02 (May-10)

Added advantage of SOC data as measure of quality of Services

• Provide an in-depth look in to a program by looking in two the practice (not aggregate)

• Facilitate live discussion between the site support team and site level providers on the identified success or problem areas & draw action points

• Guide the site support team to prioritize and focus areas for intense mentoring

Added advantage of SOC data as measure of quality of

Services • Captures key quality indicators not

included in routine report (eg. Follow up CD4 for Pre-ART Pt;

• Compliment CQI effort by breaching the gap created due to timing of routine report compilation (ARV prophylaxis at ANC)

Future Direction• Expand the SOC assessment to capture

soft but important quality indicators in all technical areas we support and automate them

• Fully integrate the priory SOCs as part of routine SOC

• Enhanced use of SOC data for CQI

• Build the capacity of site providers to complete, interpret and act on SOC data

Thank You †መሰግናለሁ

Amesegnalehu