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Quality improvement applied science assist project
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USAID Applying Science to Strengthen and Improve Systems 1 Quality Improvement –Applied Science: Experience from 6 States in India Neerja Arora MBBS DFM DHHS MBA State Improvement Coordinator, NCT of Delhi USAID ASSIST Project
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Transcript of Quality improvement applied science assist project
USAID Applying Science to Strengthen and Improve Systems1
Quality Improvement –Applied Science: Experience from 6 States in India
Neerja Arora MBBS DFM DHHS MBAState Improvement Coordinator, NCT of Delhi
USAID ASSIST Project
USAID Applying Science to Strengthen and Improve Systems
At what scale are we working in India?
263 facilities
MOHFW
263 QI teams
12-14,000 deliveries per month
30% of deliveries in 27 High Priority Districts
USAID Applying Science to Strengthen and Improve Systems
263 teams are working to improve RMNCH+A services:
Most teams:• Antenatal care • Intra-partum care• Immediate postpartum care • Essential newborn care Some teams:- Neonatal resuscitation - Identification and management of anemia- Identification and management of pregnancy
associated hypertension- Diarrhea management in children- ARSH clinics 3
USAID Applying Science to Strengthen and Improve Systems4
Results
USAID Applying Science to Strengthen and Improve Systems
Improving Antenatal Care in Zonal Hospital, Mandi in Himachal Pradesh
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USAID Applying Science to Strengthen and Improve Systems
Antenatal care in Mandi, Himachal Pradesh
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100Denominator: Number of ANCs conducted per week in Mandi, Himachal Pradesh (average = 45.6)
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Percentage of ANCs during which BP and Hb were measured in Mandi, Himachal Pradesh, July 2013-March 2014
% BP measured
% Hb measured
USAID Applying Science to Strengthen and Improve Systems
Antenatal care in Mandi, Himachal Pradesh
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Number of high-risk pregnancies identified and percentage of ANCs during which BP and Hb were measured in Mandi, Himachel Pradesh
# high-risk identified % BP measured % Hb measured
18 high-risk pregnancies identified (1.4%)
39 high-risk pregnancies identified (12.3%)
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USAID Applying Science to Strengthen and Improve Systems
Improving Delivery Care in District Women’s Hospital, Pauri in
Uttarakhand
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USAID Applying Science to Strengthen and Improve Systems
Change in management of delivery cases on the basis of partographs, at District Women’s Hospital, Pauri in Uttarakhand
July-September 2014
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Management changed for 21 cases on the basis of partographs
Maternal Hypertension- 6 casesMaternal Hypotension- 4 casesAltered Fetal Heart Rate- 4 casesMeconium stained liquor- 5 cases
Timely referral of 4 cases
Cases referred with duly filled partographsNo patient delivered in the ambulance!
USAID Applying Science to Strengthen and Improve Systems
Improving Post-partum Care in Bhagwan Mahavir HospitalNorth-West district in Delhi
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USAID Applying Science to Strengthen and Improve Systems11
Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-140
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Improving Postpartum Monitoring for early detection of complications to reduce maternal mortality-
Bhagwan Mahavir Hospital, Delhi
Number of postpartum women identified with postpartum danger signsAverage number of documented postpartum monitorings
BaselineImproving early pick-up of complications under new system of careObservation roomPartnering with patients’ attendants
Improving the frequency of monitoringInvolvement of doctors & nursesSharing of work between Labor room & PP wardUse of opportunity for care
USAID Applying Science to Strengthen and Improve Systems
Major Indicators: All StatesImproving routine care of mothers and babies
Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-140%
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12-14,000 deliveries per month30% of deliveries in the High Priority DistrictsMothers who received In-
jection Oxytocin 10IU I/M for AMTSL
Newborns given injection Vitamin K
Women whose Hemoglobin was checked during ANC
Newborns Breastfed within one hour of birth
USAID Applying Science to Strengthen and Improve Systems13
How these results were obtained
USAID Applying Science to Strengthen and Improve Systems
6 steps to improve care
1. Defining the improvement aim
2. Forming the improvement team
3. Understanding the current system
4. Developing a measurement system• Developing indicators • Plotting a time-series
chart 5. Developing changes6. Testing and implementing
changes
USAID Applying Science to Strengthen and Improve Systems15
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