RT Journal Article
SR Electronic
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
FD British Medical Journal Publishing Group
SP e000408
DO 10.1136/bmjoq-2018-000408
VO 8
IS 1
A1 Stephen Mehanni
A1 Dhiraj Jha
A1 Anirudh Kumar
A1 Nandini Choudhury
A1 Binod Dangal
A1 Grace Deukmedjian
A1 Santosh Kumar Dhungana
A1 Bikash Gauchan
A1 Tula Krishna Gupta
A1 Scott Halliday
A1 S P Kalaunee
A1 Ramesh Mahar
A1 Sanjaya Poudel
A1 Anant Raut
A1 Ryan Schwarz
A1 Dipendra Raman Singh
A1 Aradhana Thapa
A1 Roshan Thapa
A1 Lena Wong
A1 Duncan Maru
A1 Dan Schwarz
YR 2019
UL http://bmjopenquality.bmj.com/content/8/1/e000408.abstract
AB 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.