Reducing low birth weight through home visitation: a randomized controlled trial.

Background: Poor birth outcomes increase the risk of infant mortality and morbidity, developmental delays, and child maltreatment. This study assessed the effectiveness of a prenatal home-visitation program in reducing adverse birth outcomes among socially disadvantaged pregnant women and adolescents.

Design: As part of a larger RCT, this study examined the effects of home-visitation services on low birth weight (LBW) deliveries.

A framework for institutionalizing quality assurance.

Objective: To develop a framework to support the institutionalization of quality assurance (QA).

Design: The framework for institutionalizing QA consists of a model of eight essential elements and a 'roadmap' for the process of institutionalization. The essential elements are the building blocks required for implementing and sustaining QA activities.

Measuring the quality of supervisor-provider interactions in health care facilities in Zimbabwe.

Objective: Measuring performance is the first step on the road to improving it. This report presents the results of an exploratory study sponsored by the Quality Assurance (QA) Project to describe and quantify the quality of supervisor-provider interactions in health care facilities in Zimbabwe in 1999. Supervisors were district and municipal nursing officers who are responsible for guiding, assisting, and motivating health providers at government and missionary health facilities.

Methods for assessing quality of provider performance in developing countries.

Objective: To compare the effectiveness of methods for assessing the quality of pediatric outpatient health provider performance in developing countries.

Design: Exit interviews, record reviews, and provider interview results were compared with those of direct observation of pediatric patient care. Thirty health care providers in 14 facilities in Lilongwe District, Malawi were interviewed and observed, treating 436 children in August 1994.

Improving performance with clinical standards: the impact of feedback on compliance with the integrated management of childhood illness algorithm in Niger, West Africa.

The joint BASICS/Quality Assurance Project tested several research-based interventions in three districts in Niger, West Africa to improve case management of sick children. The research design was a non-concurrent, prospective case control design. Quality of care was determined as the degree of compliance of health care workers with the Integrated Management of Childhood Illness (IMCI) standards of assessment, treatment and counselling of sick children and their caretakers.

Comparative validity of three methods for assessment of the quality of primary health care.

Objective: This study compared the sensitivity and specificity of three assessment methods to detect the performance of key clinical tasks by health workers in a primary care setting.

Design: Health worker performance during patient encounters for acute respiratory infections, acute diarrhea and family planning counseling was assessed through checklist-based observation of the consultation, interview with the mother following the consultation, and review of the patient's clinical record. The results of each method regarding the performance of key tasks by health workers were compared to a 'gold standard', defined as the application of the observation checklist by observers with extensive quality assessment experience.

The occupational health status of African-American women health care workers.

Race, ethnicity, and gender are significant indicators of occupational status, general health status, and thus, occupational health status. Although African-American women constitute only 6.8% of the total U.

Reducing patient waiting times through quality assurance methods in La Troncal, Ecuador.

Long patient waiting time is a common problem in hospitals and urban health centers in Ecuador and elsewhere. Besides being a leading cause of patient dissatisfaction with health service quality, it is often related to short doctor-patient contact times that in turn can seriously reduce the technical quality of care. This article describes a quality improvement effort undertaken by the staff of the La Troncal Health Center in Ecuador, with the assistance of a quality assurance project of the University Research Corporation and the Ecuadorian Ministry of Health.

Lessons learned in institutionalization of quality assurance programs: an international perspective.

A sustainable quality assurance (QA) program depends on development of a QA structure, ongoing standard setting, routine monitoring, quality improvement activities and the development of a culture of quality. A review of QA implementation in five countries identifies some practical guidelines for successful institutionalization of QA. These experiences underscore the importance of organizational assessment and provide insight about the advantages and disadvantages of an initial QA assessment.

Clinical practice and the use of laboratory tests at the May 15 Hospital in Egypt.

The purpose of this study was to assess physicians' practices in the use of laboratory tests at a public hospital in Egypt. Methods included medical record reviews, interviews with selected physicians, literature review, and cost analysis. Three variables were examined in the medical record: appropriateness of laboratory tests, laboratory tests performed but not used as a basis for clinical treatment, and laboratory tests requested but not performed.

Quality assurance in transition.

This paper outlines the early approaches to quality assurance, and its transition from business to health care. It then describes the development of the more recent trends in quality assurance of Total Quality Management and Continuous Quality Improvement and discusses the strengths and weaknesses of these approaches. The paper then goes on to show how these approaches have been modified for application to peripheral health services in developing countries through the work of the Primary Health Care Operations Research Project and the Quality Assurance Project.

Parent education for adolescent mothers.

Adolescent parents are often ill prepared to provide their new babies with the care and stimulation they need for satisfactory development. A series of age-paced parent education booklets was designed to help these young parents acquire the information, knowledge, and confidence they need to improve their parenting practices. This is a report of a study designed to evaluate the impact of this parent education program on the parenting practices of adolescent mothers.

The Quality Assurance Project: introducing quality improvement to primary health care in less developed countries.

Persistently excessive morbidity and mortality rates in less developed countries (LDCs) served by primary health care systems suggest that the quality of services is inadequate. The PRICOR project, sponsored by the United States Agency for International Development, has designed and implemented methods for quality assessment and problem solving in LDC health systems. After developing comprehensive lists of essential activities and tasks, similar to practice parameters, for seven child survival interventions, PRICOR supported comprehensive quality assessment studies in twelve LDC countries.

Group psychotherapy with methadone-maintained pregnant women.

This article describes a group model of treatment for methadone-maintained pregnant women. Its purpose is to help health care providers alter their own stereotypical attitude toward this population by highlighting the beneficial aspects of group psychotherapy. Special emphasis is placed on developing a comprehensive care program with a biopsychosocial orientation.