QUOTE TB Light
Sara Massaut, Senior Project Officer, TB CAP/KNCV
ACSM sub-working group meeting November 30 and December 1, 2009
Cancun, Mexico
Contents
• Introduce QUOTETB Light—a patient
centered approach
• Experiences from
the field (Nigeria)
• Issues and the way
forward
Background
• Quality Of Care
Through the Eyes of
the Patient
• Developed and piloted
in Kenya, Malawi,
Uganda Published
2007
• Collaboration between
KNCV, KIT, NIVEL and
RCQHC
QUOTE-TB
• To measure performance of health
services through the eyes of the patient
weighted by what patients find
important.
• Experience showed that application was
complex with a strict scientific and
costly approach.
• Develop QUOTE-TB Light
What is QUOTE TB Light?
• More user-friendly
application of the original
QUOTE-TB
• A “ready to use” package
with standardized
instruments for application
• Pictogram cards to
measure importance
• Questionnaire to
measure performance
• Data entry worksheet to
calculate Quality Impact
Quality Dimensions
•
•
•
•
•
•
•
•
•
Communication and Information
Professional Competence
Availability of services
Patient provider interaction and
counseling
TB/HIV relationship
Support
Infrastructure
Stigma
Affordability
QUOTE TB-Light in three steps
Step 1: Establish the
Importance ranking score of
nine quality dimensions
that are important to patients
(FGD).
Step 2: Establish the
Performance score for TB
care as provided by the
health facility (Individual
Interviews)
Step 3: Calculate the
quality impact scores of the
TB care. (Importance score X
Performance score X 10)
Set up of Field test in Nigeria
• Three weeks in with two teams: TB
CAP, NTBLCP, State Supervisor and
ILEP
• 8 facilities—one per day—in four
States.
• 4 FGDs with average 8 patients
each
• 77 individual patient interviews to
assess performance of health
facilities
Results 1
Quality Dimensions and
TB Care Services
Affordability
Importance
Score
Performance
Score (% negative
responses)
Quality
Impact
>0.75
61%
No Pay for TB services
61%
0%
0.0
No tip for TB services
61%
0%
0.0
Professional Competence
83%
Home based TB treatment
83%
65%
5.4
Contact tracing
83%
61%
5.0
Support
47%
Support for transport
47%
100%
4.7
Support for food
47%
100%
4.7
Results 2
Quality Dimensions and
TB Care Services
Communication and
Information
Importance
Score
Performance
Score (% negative
responses)
Quality
Impact
>0.75
94%
Drug side effects
94%
40%
3.8
Stop spreading TB
94%
34%
3.2
Stigma
17%
Stigmatizing communication
17%
5%
0.09
Welcoming atmosphere
17%
3%
0.04
Summary findings Nigeria
• Health Education is a major issue
to be addressed—informing about
and understanding illness is
essential.
• Providing food and transport
support is important to TB
patients; what are feasible
interventions for TB programs?
• Stigma does not seem to be a big
issue
Issues and Way Forward
• Application during routine supervision vs
OR approach?
• Patients who do not come to the facility
for care are not included.
• Translating results into interventions?
• Patient involvement
• District level vs national
Loose Ends
• Introduction during
Patient Centered
Approach session on
Dec 4 from 9-12 at
the Fiesta America
Grand Coral Beach
Hotel (Coral Gallery
1C)
• Send questions and
experiences of use to
Sara Massaut at
[email protected]
• www.tbcta.org
Acknowledgements
Dr. Mansur Kabir, NTBLCP
Jumoke Onazi, TB CAP Nigeria
Emmy van der Grinten, TB CAP Nigeria
Sani Useni, NLR
Tolu Oguntimehin, TLM
Abebayo Peters, NTBLCP
Apanda Goje, Kaduna STBLCP
TB Patients in Kaduna, Kwara, Bauchi and Abuja that
particiapted in field testing
Jacques van der Broek, KNCV
Anke van der Kwaak, KIT
Herman Sixma, NIVEL