Using Continuous Quality Improvement approaches to identify facility-based innovations to increase

retention of TB/HIV co-infected patients on treatment in Uganda

Authors: K. Mutesasira, D. Murdoch, N. Tumwesigye, A. Muhwezi, A. Musisi, M. Irige, H.Mutabarura, E. Alunguru, S. Muchuro

Presenter: Kenneth Mutesasira

3 July 2013

Methods

• Trained providers in basic TB/HIV co-management and application of continuous quality improvement (QI) approaches

• Supported TB process improvement team formation and application of QI methods using onsite QI coaching and clinical mentorship approaches

Quality Improvement Model

Objective: To improve TB treatment completion towards the National target of 85%

TB care providers measure and track performance

Regular team review and updating of patient records

Capturing of patient phone numbers to enable patient tracking

Initiation of regular cohort reviews to identify and track missing patients using telephone calls and in collaboration with the district TB supervisor

Implementation of family-supported DOT

Patient referral to treatment facilities closer to home

Implemented change package and results

Apr-Jun '11

Jul-Sep '11

Oct-Dec '11

Jan-Mar '12

Apr-Jun '12

Jul-Sep '12

0

10

20

30

40

50

60

70

80

25

4252 51

55

68

Aggregated TB treatment completion rates; 16 project-supported hospitals

% T

B p

atie

nts

com

plet

ing

treat

men

t

CQI training & team

formation

Quarterly mentorship

& QI coaching

Orientation on indicator

definitions and reporting tools

Integrated clinical

mentoring and QI coaching

Lessons and Implications

• Improvements in retention of TB/HIV patients on treatment can be achieved through simple, routine facility-based interventions identified and implemented using QI approaches

• Provider involvement in performance measurement enhances ownership and motivation for implementation of improvement changes

• Integrating clinical mentorship and QI coaching facilitates rapid improvements

• More work remains to uphold the improvements gained from application of QI approaches