Assessing the quality of tuberculosis care using routine surveillance data: a process evaluation employing the Zero TB Indicator Framework in Mongolia
Objectives To evaluate the feasibility of the Zero TB Indicator Framework as a tool for assessing the quality of tuberculosis (TB) case-finding, treatment and prevention services in Mongolia.Setting Primary health centres, TB dispensaries, and surrounding communities in four districts of Mongolia.De...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/8/e061229.full |
| _version_ | 1798037181120380928 |
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| author | Donna Spiegelman Xin Zhou J Lucian Davis Meredith B Brooks Ariunzaya Saranjav Christina Parisi Khulan Dorjnamjil Tumurkhuyag Samdan Sumiya Erdenebaatar Altantogoskhon Chuluun Tserendagva Dalkh Gantungalag Ganbaatar Davaasambuu Ganmaa |
| author_facet | Donna Spiegelman Xin Zhou J Lucian Davis Meredith B Brooks Ariunzaya Saranjav Christina Parisi Khulan Dorjnamjil Tumurkhuyag Samdan Sumiya Erdenebaatar Altantogoskhon Chuluun Tserendagva Dalkh Gantungalag Ganbaatar Davaasambuu Ganmaa |
| author_sort | Donna Spiegelman |
| collection | DOAJ |
| description | Objectives To evaluate the feasibility of the Zero TB Indicator Framework as a tool for assessing the quality of tuberculosis (TB) case-finding, treatment and prevention services in Mongolia.Setting Primary health centres, TB dispensaries, and surrounding communities in four districts of Mongolia.Design Three retrospective cross-sectional cohort studies, and two longitudinal studies each individually nested in one of the cohort studies.Participants 15 947 community members from high TB-risk populations; 8518 patients screened for TB in primary health centres and referred to dispensaries; 857 patients with index TB and 2352 household contacts.Primary and secondary outcome measures 14 indicators of the quality of TB care defined by the Zero TB Indicator Framework and organised into three care cascades, evaluating community-based active case-finding, passive case-finding in health facilities and TB screening and prevention among close contacts; individual and health-system predictors of these indicators.Results The cumulative proportions of participants receiving guideline-adherent care varied widely, from 96% for community-based active case-finding, to 79% for TB preventive therapy among household contacts, to only 67% for passive case-finding in primary health centres and TB dispensaries (range: 29%–80% across districts). The odds of patients completing active TB treatment decreased substantially with increasing age (aOR: 0.76 per decade, 95% CI: 0.71 to 0.83, p<0.001) and among men (aOR: 0.56, 95% CI: 0.36 to 0.88, p=0.013). Contacts of older index patients also had lower odds of initiating and completing of TB preventive therapy (aOR: 0.60 per decade, 95% CI: 0.38 to 0.93, p=0.022).Conclusions The Zero TB Framework provided a feasible and adaptable approach for using routine surveillance data to evaluate the quality of TB care and identify associated individual and health system factors. Future research should evaluate strategies for collecting process indicators more efficiently; gather qualitative data on explanations for low-quality care; and deploy quality improvement interventions. |
| first_indexed | 2024-04-11T21:23:05Z |
| format | Article |
| id | doaj.art-71db13d3d32f416d8cdd1d923c21fd2b |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-11T21:23:05Z |
| publishDate | 2022-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-71db13d3d32f416d8cdd1d923c21fd2b2022-12-22T04:02:32ZengBMJ Publishing GroupBMJ Open2044-60552022-08-0112810.1136/bmjopen-2022-061229Assessing the quality of tuberculosis care using routine surveillance data: a process evaluation employing the Zero TB Indicator Framework in MongoliaDonna Spiegelman0Xin Zhou1J Lucian Davis2Meredith B Brooks3Ariunzaya Saranjav4Christina Parisi5Khulan Dorjnamjil6Tumurkhuyag Samdan7Sumiya Erdenebaatar8Altantogoskhon Chuluun9Tserendagva Dalkh10Gantungalag Ganbaatar11Davaasambuu Ganmaa12Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USABiostatistics, Yale School of Public Health, New Haven, Connecticut, USASan Francisco General Hospital, Pulmonary Division, 5k1, 1001 Potrero Ave, San Francisco, California, CA 94110, USADepartment of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USAZero TB Mongolia, Mongolian Health Initiative, Ulaanbaatar, MongoliaDepartment of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USAZero TB Mongolia, Mongolian Health Initiative, Ulaanbaatar, MongoliaZero TB Mongolia, Mongolian Health Initiative, Ulaanbaatar, MongoliaZero TB Mongolia, Mongolian Health Initiative, Ulaanbaatar, MongoliaUlaanbaatar City Health Department, Governor’s Office of Capital City Ulaanbaatar, Ulaanbaatar, MongoliaDepartment of Hospital Development, Mongolian National University of Medical Sciences, Ulaanbaatar, MongoliaTuberculosis Surveillance and Research Department, National Center for Communicable Diseases, Ulaanbaatar, MongoliaDepartment of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USAObjectives To evaluate the feasibility of the Zero TB Indicator Framework as a tool for assessing the quality of tuberculosis (TB) case-finding, treatment and prevention services in Mongolia.Setting Primary health centres, TB dispensaries, and surrounding communities in four districts of Mongolia.Design Three retrospective cross-sectional cohort studies, and two longitudinal studies each individually nested in one of the cohort studies.Participants 15 947 community members from high TB-risk populations; 8518 patients screened for TB in primary health centres and referred to dispensaries; 857 patients with index TB and 2352 household contacts.Primary and secondary outcome measures 14 indicators of the quality of TB care defined by the Zero TB Indicator Framework and organised into three care cascades, evaluating community-based active case-finding, passive case-finding in health facilities and TB screening and prevention among close contacts; individual and health-system predictors of these indicators.Results The cumulative proportions of participants receiving guideline-adherent care varied widely, from 96% for community-based active case-finding, to 79% for TB preventive therapy among household contacts, to only 67% for passive case-finding in primary health centres and TB dispensaries (range: 29%–80% across districts). The odds of patients completing active TB treatment decreased substantially with increasing age (aOR: 0.76 per decade, 95% CI: 0.71 to 0.83, p<0.001) and among men (aOR: 0.56, 95% CI: 0.36 to 0.88, p=0.013). Contacts of older index patients also had lower odds of initiating and completing of TB preventive therapy (aOR: 0.60 per decade, 95% CI: 0.38 to 0.93, p=0.022).Conclusions The Zero TB Framework provided a feasible and adaptable approach for using routine surveillance data to evaluate the quality of TB care and identify associated individual and health system factors. Future research should evaluate strategies for collecting process indicators more efficiently; gather qualitative data on explanations for low-quality care; and deploy quality improvement interventions.https://bmjopen.bmj.com/content/12/8/e061229.full |
| spellingShingle | Donna Spiegelman Xin Zhou J Lucian Davis Meredith B Brooks Ariunzaya Saranjav Christina Parisi Khulan Dorjnamjil Tumurkhuyag Samdan Sumiya Erdenebaatar Altantogoskhon Chuluun Tserendagva Dalkh Gantungalag Ganbaatar Davaasambuu Ganmaa Assessing the quality of tuberculosis care using routine surveillance data: a process evaluation employing the Zero TB Indicator Framework in Mongolia BMJ Open |
| title | Assessing the quality of tuberculosis care using routine surveillance data: a process evaluation employing the Zero TB Indicator Framework in Mongolia |
| title_full | Assessing the quality of tuberculosis care using routine surveillance data: a process evaluation employing the Zero TB Indicator Framework in Mongolia |
| title_fullStr | Assessing the quality of tuberculosis care using routine surveillance data: a process evaluation employing the Zero TB Indicator Framework in Mongolia |
| title_full_unstemmed | Assessing the quality of tuberculosis care using routine surveillance data: a process evaluation employing the Zero TB Indicator Framework in Mongolia |
| title_short | Assessing the quality of tuberculosis care using routine surveillance data: a process evaluation employing the Zero TB Indicator Framework in Mongolia |
| title_sort | assessing the quality of tuberculosis care using routine surveillance data a process evaluation employing the zero tb indicator framework in mongolia |
| url | https://bmjopen.bmj.com/content/12/8/e061229.full |
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