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Magnitude and pattern of improvement in processes of care for hospitalised children with diarrhoea and dehydration in Kenyan hospitals participating in a clinical network
Author(s) -
Akech Samuel,
Ayieko Phillip,
Irimu Grace,
Stepniewska Kasia,
English Mike
Publication year - 2019
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13176
Subject(s) - medicine , observational study , psychological intervention , kenya , clinical practice , pediatrics , emergency medicine , family medicine , nursing , political science , law
Abstract Objective WHO recommends optimisation of available interventions to reduce deaths of under‐five children with diarrhoea and dehydration ( DD ). Clinical networks may help improve practice across many hospitals but experience with such networks is scarce. We describe magnitude and patterns of changes in processes of care for children with DD over the first 3 years of a clinical network. Methods Observational study involving children aged 2–59 months with DD admitted to 13 hospitals participating in the clinical network. Processes of individual patient care including agreement of assessment, diagnosis and treatment according to WHO guidelines were combined using the composite Paediatric Admission Quality of Care ( PAQC ) score (range 0–6). Results Data from 7657 children were analysed and improvements in PAQC scores were observed. Predicted mean PAQC score for all the hospitals at enrolment was 59.8% (95% CI : 54.7, 64.9) but showed a wide variation (variance 10.7%, 95% CI : 5.8, 19.6). Overall mean PAQC score increased by 13.8% (95% CI : 8.7–18.9, SD between hospitals: ±8.2) in the first 12 months, with an average 0.9% (95% CI : 0.3–1.5, SD  ± 1.0) increase per month and plateaued thereafter, and changes were similar in two groups of hospitals joining the network at different times. Conclusion Adherence to guidelines for children admitted with DD can be improved through participation in a clinical network but improvement is limited, not uniform for all aspects of care and contexts and occurs early. Future research should address these issues.

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