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Improving Health: The Heart of the Matter
TABLE 3.2
Summary of Interventions to Improve Quality of Care Type of interventions
Level of evidence on effectiveness
Interventions changing structural conditions Legal mandates, accreditation, and administrative regulations
+
Malpractice litigation to enforce legal mandate
++
Oversight of professional association
++
Clinical guidelines
+++
Targeted education and professional retraining
+++
Organizational change (management models, among others)
++++
Interventions directly affecting provider practices Training with peer review feedbacks
+++
Pay-for-performance
++++
High volume of care
++++
Performance-based professional recognition
++++
Source: Adapted from Peabody et al. 2006. Note: Level of evidence is ranked from “Low” (+) to “High” (++++).
The global body of evidence on effective interventions to improve the quality of care is quite well established (table 3.2), but their application remains limited. For example, a review of the existence of national practice guidelines for selected cardiovascular conditions in three ECA countries in 2011 showed that two did not have any at the national level. In the quality-of-care survey, on average, only 65 percent of hospitals in Armenia, Georgia, Russia (Kirov oblast), and Tajikistan had a committee to oversee quality of care, although such bodies are an essential part of the quality management model. Similarly, about 43 percent of health facilities in these countries had not received any kind of supervisory visit in the past 12 months. Among those that did, only 7 percent of external supervisors had used a checklist to assess the structural quality of care, and only 8 percent had reviewed medical registers. Internal quality control is also deficient, with only about half of all health facilities having applied inventory checklists and medical register audits to themselves, and only half of hospitals had conducted a mortality audit in the event of a death. With regard to continuing medical education, a key intervention commonly used globally to update health workers’ professional knowledge and skills, only 38 percent of hospital physicians and 29 percent of primary-care physicians in Tajikistan had received any type of continuing medical training in the past 12 months. For the Kirov oblast in Russia, these rates were 40 and 48 percent, respectively.
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