Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units

Collaboration for Research, Implementation and Training in Critical Care in Asia and Africa (CCAA) , Rashan A 1 , Beane A 2 , Ghose A 3 , Dondorp AM 4 , Kwizera A 5 Show all authors , Vijayaraghavan BKT 6 , Biccard B 7 , Righy C 8 , Thwaites CL 9 , Pell C 10 , Sendagire C 11 , Thomson D 7 , Done DG 12 , Aryal D 4 , Wagstaff D 7 , Nadia F 13 , Putoto G 14 , Panaru H 15 , Udayanga I 12 , Amuasi J 16 , Salluh J 17 , Gokhale K 18 , Nirantharakumar K 18 , Pisani L 4 , Hashmi M 4 , Schultz M 19 , Ghalib MS 20 , Mukaka M 4 , Mat-Nor MB 13 , Siaw-Frimpong M 21 , Surenthirakumaran R 22 , Haniffa R 2 , Kaddu RP 23 , Pereira SP 24 , Murthy S 25 , Harris S 26 , Moonesinghe SR 24 , Vengadasalam S 27 , Tripathy S 2 , Gooden TE 18 , Tolppa T 12 , Pari V 28 , Waweru-Siika W 23 , Minh YL 29

Affiliations 

  • 1 Institute of Health Informatics, University College London, London, UK
  • 2 Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
  • 3 Department of Medicine, Chittagong Medical College Hospital, Chattogram, Bangladesh
  • 4 Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
  • 5 Department of Anaesthesia and Intensive Care Medicine, Makerere University, Kampala, Uganda
  • 6 Department of Critical Care Medicine, Apollo Hospitals Educational and Research Foundation, Chennai, India
  • 7 Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
  • 8 National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
  • 9 Nuffield Department of Medicine, University of Oxford, Oxford, UK
  • 10 Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
  • 11 Uganda Heart Institute, University of Makerere, Makerere, Uganda
  • 12 Nat-Intensive Care Surveillance, Mahidol Oxford Tropical Medicine Research Unit, Colombo, Sri Lanka
  • 13 Department of Intensive Care Anaesthesiology, International Islamic University Malaysia, Kuala Lumpur, Malaysia
  • 14 Department of Planning and Operational Research, Doctors with Africa CUAMM, Padova, Italy
  • 15 Department of Critical Care, Nepal Intensive Care Research Foundation, Kathmandu, Nepal
  • 16 Department of Global Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  • 17 D'Or Institute for Research and Education, Sao Paulo, Brazil
  • 18 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  • 19 Intensive Care Medicine, University of Amsterdam, Amsterdam, The Netherlands
  • 20 General Surgery, Wazir Akbar Khan Hospital, Kabul, Afghanistan
  • 21 Department of Anaesthesiology and Intensive care, Komfo Anokye Teaching Hospital, Kumasi, Ghana
  • 22 Department of Community and Family Medicine, University of Jaffna, Jaffna, Sri Lanka
  • 23 Department of Anaesthesia, The Aga Khan University, Nairobi, Kenya
  • 24 Department of Targeted Intervention, University College London, London, UK
  • 25 Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
  • 26 Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
  • 27 Teaching Hospital Jaffna, Jaffna, Sri Lanka
  • 28 Chennai Critical Care Consultants Private Limited, Chennai, India
  • 29 Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam
Wellcome Open Res, 2023;8:29.
PMID: 37954925 DOI: 10.12688/wellcomeopenres.18710.3

Abstract

BACKGROUND: Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes.

METHODS: Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be led by local stakeholders, performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam.

CONCLUSIONS: The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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