tailieunhanh - Integrated clinical and quality improvement coaching in Son La Province, Vietnam: A model of building public sector capacity for sustainable HIV care delivery

We successfully built capacity of a team of public sector health care workers to provide integrated coaching in both clinical skills and QI across a province. The PCT is a feasible and effective model to spread and sustain quality activities and improve HIV care services in a decentralized rural setting. | Cosimi et al. BMC Health Services Research 2015 15 269 DOI S12913-015-0935-8 BMC Health Services Research RESEARCH ARTICLE Open Access Integrated clinical and quality improvement coaching in Son La Province Vietnam a model of building public sector capacity for sustainable HIV care delivery I I A f f I I 1 2I_11 I V Z-M Ph 3 I h V ỉ I Z I I rr v v4 I_I I ĩr vx I I_I z 3 D h I I V Z-M I Ph - 4 PhI I ỉ I Ph I I 4 Lisa A. Cosimi Huong V. Dam inai Q. Nguyen Huyen I. Ho Phuong I. DO Duat N. Duc Huong T. Nguyen4 Bridget Gardner2 Howard Libman2 Todd Pollack4 and Lisa R. Hirschhorn1 5 6 Abstract Background The global scale-up of antiretroviral therapy included extensive training and onsite support to build the capacity of HIV health care workers. However traditional efforts aimed at strengthening knowledge and skills often are not successful at improving gaps in the key health systems required for sustaining high quality care. Methods We trained and mentored existing staff of the Son La provincial health department and provincial HIV clinic to work as a provincial coaching team PCT to provide integrated coaching in clinical HIV skills and quality improvement QI to the HIV clinics in the province. Nine core indicators were measured through chart extraction by clinic and provincial staff at baseline and at 6 month intervals thereafter. Coaching from the team to each of the clinics in both QI and clinical skills was guided by results of performance measurements gap analyses and resulting QI plans. Results After 18 months the PCT had successfully spread QI activities and was independently providing regular coaching to the provincial general hospital clinic and six of the eight district clinics in the province. The frequency and type of coaching was determined by performance measurement results. Clinics completed a mean of five QI projects. Quality of HIV care was improved throughout all clinics with significant increases in seven of the indicators. Overall both the PCT