TY - JOUR T1 - Implementing a quality improvement initiative for the management of chronic obstructive pulmonary disease in rural Nepal JF - BMJ Open Quality JO - BMJ Open Qual DO - 10.1136/bmjoq-2018-000408 VL - 8 IS - 1 SP - e000408 AU - Stephen Mehanni AU - Dhiraj Jha AU - Anirudh Kumar AU - Nandini Choudhury AU - Binod Dangal AU - Grace Deukmedjian AU - Santosh Kumar Dhungana AU - Bikash Gauchan AU - Tula Krishna Gupta AU - Scott Halliday AU - S P Kalaunee AU - Ramesh Mahar AU - Sanjaya Poudel AU - Anant Raut AU - Ryan Schwarz AU - Dipendra Raman Singh AU - Aradhana Thapa AU - Roshan Thapa AU - Lena Wong AU - Duncan Maru AU - Dan Schwarz Y1 - 2019/03/01 UR - http://bmjopenquality.bmj.com/content/8/1/e000408.abstract N2 - Background Chronic obstructive pulmonary disease accounts for a significant portion of the world’s morbidity and mortality, and disproportionately affects low/middle-income countries. Chronic obstructive pulmonary disease management in low-resource settings is suboptimal with diagnostics, medications and high-quality, evidence-based care largely unavailable or unaffordable for most people. In early 2016, we aimed to improve the quality of chronic obstructive pulmonary disease management at Bayalpata Hospital in rural Achham, Nepal. Given that quality improvement infrastructure is limited in our setting, we also aimed to model the use of an electronic health record system for quality improvement, and to build local quality improvement capacity.Design Using international chronic obstructive pulmonary disease guidelines, the quality improvement team designed a locally adapted chronic obstructive pulmonary disease protocol which was subsequently converted into an electronic health record template. Over several Plan-Do-Study-Act cycles, the team rolled out a multifaceted intervention including educational sessions, reminders, as well as audits and feedback.Results The rate of oral corticosteroid prescriptions for acute exacerbations of chronic obstructive pulmonary disease increased from 14% at baseline to >60% by month 7, with the mean monthly rate maintained above this level for the remainder of the initiative. The process measure of chronic obstructive pulmonary disease template completion rate increased from 44% at baseline to >60% by month 2 and remained between 50% and 70% for the remainder of the initiative.Conclusion This case study demonstrates the feasibility of robust quality improvement programmes in rural settings and the essential role of capacity building in ensuring sustainability. It also highlights how individual quality improvement initiatives can catalyse systems-level improvements, which in turn create a stronger foundation for continuous quality improvement and healthcare system strengthening. ER -