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Datta V, Srivastava S, Lalwani K, Garde R, Patnaik SK, Venkatagiri P, Pradeep J, Bangal V, Pemde H, Kumar A, Sooden A, Vijayan S, Sawleshwarkar K, Mehta R, Raina N, Khanna R, Singh V, Singh P, Saha K, Sharma C, Jain S. Creating and sustaining a digital community of practice for quality improvement in South-East Asia during the COVID-19 pandemic. BMJ Open Qual 2023; 12:e002370. [PMID: 37863508 PMCID: PMC10603542 DOI: 10.1136/bmjoq-2023-002370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/11/2023] [Indexed: 10/22/2023] Open
Abstract
INTRODUCTION Ensuring quality of care in Low and Middle Income countries (LMICs) is challenging. Despite the implementation of various quality improvement (QI) initiatives in public and private sectors, the sustenance of improvements continues to be a major challenge. A team of healthcare professionals in India developed a digital community of practice (dCoP) focusing on QI which now has global footprints. METHODOLOGY The dCoP was conceptualised as a multitiered structure and is operational online at www.nqocncop.org from August 2020 onwards. The platform hosts various activities related to the quality of care, including the development of new products, and involves different cadres of healthcare professionals from primary to tertiary care settings. The platform uses tracking indicators, including the cost of sustaining the dCoP to monitor the performance of the dCoP. RESULT Since its launch in 2020, dCoP has conducted over 130 activities using 13 tools with 25 940 registration and 13 681 participants. From April 2021, it has expanded to countries across the South-East Asia region and currently has participants from 53 countries across five continents. It has developed 20 products in four thematic areas for a targeted audience. dCoP is supporting mentoring of healthcare professionals from five countries in the South-East Asia region in their improvement journey. Acquiring new knowledge and improvement in their daily clinical practice has been reported by 93% and 80% of participants, respectively. The dCoP and its partners have facilitated the publication of nearly 40 articles in international journals. CONCLUSION This dCoP platform has become a repository of knowledge for healthcare professionals in the South-East Asia region. The current paper summarises the journey of this innovative dCoP in an LMIC setting for a wider global audience.
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Affiliation(s)
- Vikram Datta
- Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences & Dr Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Sushil Srivastava
- Pediatrics, University College of Medical Sciences, New Delhi, Delhi, India
| | | | - Rahul Garde
- Quality Improvement, NQOCN, New Delhi, Delhi, India
| | - Suprabha K Patnaik
- Neonatology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharastra, India
| | | | - Jeena Pradeep
- Nursing, Ministry of Health and Family Welfare, India, New Delhi, Delhi, India
- Pediatrics, Kalawati Saran Children's Hospital, New Delhi, Delhi, India
| | - Vidhyadhar Bangal
- Obstetrics and Gynaecology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
- Centre for Social Medicine, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Harish Pemde
- Paediatrics, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Achala Kumar
- Nursing, Ministry of Health and Family Welfare, India, New Delhi, Delhi, India
| | - Ankur Sooden
- Private Sector Engagement, JSI India, New Delhi, Delhi, India
| | - Shreeja Vijayan
- Child Health Nursing, Choithram College of Nursing and Choithram Hospital & Research Centre, Indore, Madhya Pradesh, India
| | | | | | - Neena Raina
- World Health Organization - South East Asia Regional Office, New Delhi, Delhi, India
| | - Rajesh Khanna
- World Health Organization - South East Asia Regional Office, New Delhi, Delhi, India
| | - Vivek Singh
- Health Section, UNICEF India, New Delhi, Delhi, India
| | | | - Khushboo Saha
- The University of Texas Southwestern Medical Center at Dallas Library, Dallas, Texas, USA
| | - Chhavi Sharma
- Pediatrics, Kalawati Saran Children's Hospital, New Delhi, Delhi, India
| | - Sonam Jain
- Quality Improvement, NQOCN, New Delhi, Delhi, India
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Joshi A, Londhe A, Joshi T, Deshmukh L. Quality improvement in Kangaroo Mother Care: learning from a teaching hospital. BMJ Open Qual 2022; 11:bmjoq-2021-001459. [PMID: 35545277 PMCID: PMC9092177 DOI: 10.1136/bmjoq-2021-001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/09/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Kangaroo Mother Care (KMC) is a low-resource, evidence-based, high-impact intervention for low-birth weight (LBW) care. Quality improvement in KMC requires meso-level, macro-level and micro-level interventions. Our institution, a public teaching hospital, hosts a level-II/III neonatal intensive care unit (NICU). The average demand for beds typically exceeds available capacity, with 60% occupancy attributed to LBW patients. There was low uptake of KMC practice at our unit. AIM STATEMENT In the initial phase, we aimed to improve the coverage of KMC in admitted eligible neonates from a baseline of 20%-80% within 15 days. After a period of complacency, we revised the aim statement with a target of improving the percentage of babies receiving 6-hour KMC from 30% to 80% in 12 weeks. METHODS We report this quasi-experimental time-series study. With the Point of Care Quality Improvement methodology, we performed Plan-Do-Study-Act (PDSA) cycles to improve KMC practice. We involved all the healthcare workers, mothers and caregivers to customise various KMC tools (KMC book format, KMC bag, mother's gown) and minimise interruptions. Feedback from all levels guided our PDSA cycles. RESULTS The percentage of babies receiving at least 1-hour KMC increased from 20% to 100% within 15 days of August 2017. In the improvement phase, baseline 6-hour KMC coverage of 30% increased to 80% within 12 weeks (October-December 2017). It sustained for more than 2 years (January 2018 till February-2020) at 76.5%±2.49%. CONCLUSIONS Quality improvement methods helped increase the coverage and percentage of babies receiving 6-hour KMC per day in our NICU. The duration specified KMC coverage should be adopted as the quality indicator of KMC. The training of healthcare workers and KMC provider should include hands-on sessions involving the mother and the baby. Maintaining data and providing suitable KMC tools are necessary elements for improving KMC. Minimising interruption is possible with family support and appropriate scheduling of activities. Having a designated KMC block helps in peer motivation.
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Affiliation(s)
- Amol Joshi
- Neonatology, Government Medical College and Hospital Aurangabad, Aurangabad, Maharashtra, India
| | - Atul Londhe
- Neonatology, Government Medical College and Hospital Aurangabad, Aurangabad, Maharashtra, India
| | - Trupti Joshi
- Pediatrics, Government Medical College and Hospital Aurangabad, Aurangabad, Maharashtra, India
| | - Laxmikant Deshmukh
- Neonatology, Government Medical College and Hospital Aurangabad, Aurangabad, Maharashtra, India
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Breastfeeding Support in Health Facilities: A Challenge Less Recognized? Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2462-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Oleti TP, Murki S. Immediate 'Kangaroo Mother Care' and survival of infants with low birth weight. Acta Paediatr 2022; 111:445-446. [PMID: 34674298 DOI: 10.1111/apa.16117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/04/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Srinivas Murki
- Department of Neonatology Paramita Children Hospital Hyderabad India
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Datta V, Srivastava S, Garde R, Mehta R, Livesley N, Sawleshwarkar K, Pemde H, Patnaik SK, Sooden A, Singh M, John SS, Pradeep J, Vig A, Kumar A, Singh V, Bhatia V, Garg BS, Baswal D. Development of a framework of intervention strategies for point of care quality improvement at different levels of healthcare delivery system in India: initial lessons. BMJ Open Qual 2021; 10:e001449. [PMID: 34344739 PMCID: PMC8336183 DOI: 10.1136/bmjoq-2021-001449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/22/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Inadequate quality of care has been identified as one of the most significant challenges to achieving universal health coverage in low-income and middle-income countries. To address this WHO-SEARO, the point of care quality improvement (POCQI) method has been developed. This paper describes developing a dynamic framework for the implementation of POCQI across India from 2015 to 2020. METHODS A total of 10 intervention strategies were designed as per the needs of the local health settings. These strategies were implemented across 10 states of India, using a modification of the 'translating research in practice' framework. Healthcare professionals and administrators were trained in POCQI using a combination of onsite and online training methods followed by coaching and mentoring support. The implementation strategy changed to a fully digital community of practice platform during the active phase of the COVID-19 pandemic. Dashboard process, outcome indicators and crude cost of implementation were collected and analysed across the implementation sites. RESULTS Three implementation frameworks were evolved over the study period. The combined population benefitting from these interventions was 103 million. A pool of QI teams from 131 facilities successfully undertook 165 QI projects supported by a pool of 240 mentors over the study period. A total of 21 QI resources and 6 publications in peer-reviewed journals were also developed. The average cost of implementing POCQI initiatives for a target population of one million was US$ 3219. A total of 100 online activities were conducted over 6 months by the digital community of practice. The framework has recently extended digitally across the South-East Asian region. CONCLUSION The development of an implementation framework for POCQI is an essential requirement for the initiative's successful country-wide scale. The implementation plan should be flexible to the healthcare system's needs, target population and the implementing agency's capacity and amenable to multiple iterative changes.
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Affiliation(s)
- Vikram Datta
- Neonatology, Kalawati Saran Children's Hospital, New Delhi, Delhi, India
- Neonatology, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Sushil Srivastava
- Pediatrics, University College of Medical Sciences, Delhi, Delhi, India
| | - Rahul Garde
- Quality Improvement, Nationwide Quality of Care Network, New Delhi, Delhi, India
| | - Rajesh Mehta
- Newborn, Child and Adolescent Health, World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | | | | | - Harish Pemde
- Pediatrics, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Suprabha K Patnaik
- Neonatology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharastra, India
| | - Ankur Sooden
- QI, University Research Co LLC, Bethesda, Maryland, USA
- Technical Advisor Health Systems, Nationwide Quality of Care Network, Indora, Himachal Pradesh, India
| | - Mahtab Singh
- QI, Nationwide Quality Of Care Network India, New Delhi, Delhi, India
| | - Susy Sarah John
- College of Nursing, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Jeena Pradeep
- Department of Nursing, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Anupa Vig
- Telemedicine, Piramal Swasthya, Noida, NCR, India
- Obstetrics and Gynaecology, Piramal Swasthya, New Delhi, Delhi, India
| | - Achala Kumar
- Department of Nursing, Kalawati Saran Children's Hospital, Lady Hardinge Medical College, New Delhi, Delhi, India
| | | | | | - Bishan Singh Garg
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Dinesh Baswal
- Maternal Health Division, Ministry of Health and Family Welfare, Government of India, New Delhi, Delhi, India
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Bhattacharya D, Kshatri JS, Choudhary HR, Parai D, Shandilya J, Mansingh A, Pattnaik M, Mishra K, Padhi SP, Padhi A, Pati S. One Health approach for elimination of human anthrax in a tribal district of Odisha: Study protocol. PLoS One 2021; 16:e0251041. [PMID: 34043627 PMCID: PMC8158997 DOI: 10.1371/journal.pone.0251041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/11/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Anthrax is a major but neglected zoonotic disease of public health concern in India with Odisha contributing a major share to the disease burden. Bacillus anthracis spores can be found naturally in soil and commonly affect both animals and humans around the world. Domestic and wild animals such as cattle, sheep, goats, and deer can become infected when they inhale or ingest spores from contaminated soil, plants, or water. Anthrax can be fatal if patients are not treated promptly with antibiotics. This protocol aims to describe the implementation and evaluation of the 'One Health' intervention model based on the principles of Theory of Change (ToC) to eliminate human anthrax from a tribal district in Odisha, India. METHODS This study would test the effectiveness of a complex public health intervention package developed using the ToC framework for the elimination of human anthrax in Koraput district by a comparative analysis of baseline and end-line data. We plan to enroll 2640 adults across 14 geographically divided blocks in Koraput district of Odisha for baseline and end-line surveys. After baseline, we would provide capacity building training to stakeholders from the department of health, veterinary, forest, academic and allied health institutions followed by workshops on sensitization and awareness through IEC (Information Education Communication)/BCC (Behavior Change Communication) activities in the community. We would establish a state-level laboratory facility as a robust system for timely diagnosis and management of human anthrax cases. Surveillance network will be strengthened to track the cases in early stage and risk zoning will be done for focused surveillance in endemic areas. Advocacy with district level administration will be done for maximizing the coverage of livestock vaccination in the entire district. Interdepartmental coordination would be established for the effective implementation of the intervention package. CONCLUSION This would be a first study applying One Health concept for the elimination of human anthrax in India. The findings from this study will offer important insights for policy-making and further replication in other endemic regions of the state and country. TRIAL REGISTRATION The authors confirm that all ongoing and related trials for this intervention are prospectively registered with the Clinical Trials Registry of India [CTRI/2020/05/025325] on 22 May 2020.
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Affiliation(s)
- Debdutta Bhattacharya
- ICMR – Regional Medical Research Centre, Bhubaneswar, Odisha, India
- * E-mail: (SP); (DB)
| | | | | | - Debaprasad Parai
- ICMR – Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Jyoti Shandilya
- ICMR – Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Asit Mansingh
- ICMR – Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Kaushik Mishra
- Saheed Laxman Nayak Medical College & Hospital, Koraput, Odisha, India
| | | | - Arun Padhi
- Department of Public Health, Koraput, Odisha, India
| | - Sanghamitra Pati
- ICMR – Regional Medical Research Centre, Bhubaneswar, Odisha, India
- * E-mail: (SP); (DB)
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