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Quality improvement in Uzbekistan: A case study of three rural clinics

McGee, Blake Tyler

Objective: To develop an in-depth narrative of the experience of three clinic-based teams in implementing quality improvement measures for hypertension care. Design: A descriptive, qualitative case study of the three teams. Sources of data included archived program documents, semi-structured interviews with team members and other key informants, unstructured clinic observations and data from quality monitoring indicators. Setting: Three rural primary care clinics in Ferghana province, the central district hospital and the province health department. Participants: Interview respondents included physicians and nurses from the selected clinics as well as district and province health officials. Intervention: None. Main Outcome Measures: The problems identified in meeting standards of care for hypertension, the changes implemented to address those problems, the outcomes of these changes, and the perspectives of team members on current and future quality improvement activities. Results: Quality improvement teams contributed to the development of standards and began measuring indicators of compliance with those standards at their own clinics on a monthly basis. With technical assistance, teams identified causes of limited compliance with the standards and implemented changes to address these problems. Teams have documented improvements in most of the quality indicators and have participated in efforts to disseminate quality improvement principles and methods to clinics beyond their district. Conclusions: The teams described in this study exemplify the successful introduction of quality improvement measures into a post-Soviet health care system. Although clinicians show ownership over day-to-day quality monitoring tasks, independent initiative to analyze problems and pilot solutions remains undemonstrated. Moreover, clinicians seeking to improve the quality of care would benefit from further governmental support.

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More About This Work

Academic Units
Population and Family Health
Thesis Advisors
Boothby, Neil G.
Degree
M.P.H., Mailman School of Public Health, Columbia University
Published Here
October 11, 2016
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