Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units

Aasiyah Rashan, Abi Beane*, Aniruddha Ghose, Arjen M Dondorp, Arthur Kwizera, Bharath Kumar Tirupakuzhi Vijayaraghavan, Bruce Biccard, Cassia Righy, C. Louise Thwaites, Christopher Pell, Cornelius Sendagire, David Thomson, Dilanthi Gamage Done, Diptesh Aryal, Duncan Wagstaff, Farah Nadia, Giovanni Putoto, Hem Panaru, Ishara Udayanga, John AmuasiJorge Salluh, Krishna Gokhale, Krishnarajah Nirantharakumar, Luigi Pisani, Madiha Hashmi, Marcus Schultz, Maryam Shamal Ghalib, Mavuto Mukaka, Mohammed Basri Mat-Nor, Moses Siaw-frimpong, Rajendra Surenthirakumaran, Rashan Haniffa, Ronnie P Kaddu, Snehal Pinto Pereira, Srinivas Murthy, Steve Harris, Suneetha Ramani Moonesinghe, Sutharshan Vengadasalam, Swagata Tripathy, Timo Tolppa, Vrindha Pari, Wangari Waweru-Siika, Yen Lam Minh, The Collaboration for Research, Implementation and Training in Critical Care in Asia and Africa (CCAA)

*Corresponding author for this work

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Background: Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes.

Methods: Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam.

Conclusions: The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services.
Original languageEnglish
Article number29
Number of pages21
JournalWellcome Open Research
Publication statusPublished - 1 Nov 2023

Bibliographical note

This study was funded by a Wellcome Innovations Flagship Programme grant and UKRI/MRC award (Wellcome grant number: 215522, https://doi.org/10.35802/215522, UKRI/ MRC grant number: MR/V030884/1). They had no role in the design, analysis or reporting of this protocol.


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