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The effectiveness of the quality improvement collaborative strategy in low- and middleincome countries: A systematic review and meta-analysis

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dc.contributor.author Garcia-Elorrio, Ezequiel
dc.contributor.author Rowe, Samantha Y.
dc.contributor.author Teijeiro, Maria E.
dc.contributor.author Ciapponi, Agustín
dc.contributor.author Rowe, Alexander K.
dc.date.accessioned 2019-10-30T17:43:07Z
dc.date.available 2019-10-30T17:43:07Z
dc.date.issued 2019-10-03
dc.identifier.citation Garcia-Elorrio E, Rowe SY, Teijeiro ME, Ciapponi A, Rowe AK. The effectiveness of the quality improvement collaborative strategy in low- and middle-income countries: A systematic review and meta-analysis. PLoS ONE. 2019;14(10):e0221919. doi:10.1371/journal.pone.0221919 en_US
dc.identifier.uri https://doi.org/10.1371/journal.pone.0221919
dc.identifier.uri https://repositorio.fleni.org.ar/handle/123456789/90
dc.description.abstract BACKGROUND: Quality improvement collaboratives (QICs) have been used to improve health care for decades. Evidence on QIC effectiveness has been reported, but systematic reviews to date have little information from low- and middle-income countries (LMICs). OBJECTIVE: To assess the effectiveness of QICs in LMICs. METHODS: We conducted a systematic review following Cochrane methods, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for quality of evidence grading, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement for reporting. We searched published and unpublished studies between 1969 and March 2019 from LMICs. We included papers that compared usual practice with QICs alone or combined with other interventions. Pairs of reviewers independently selected and assessed the risk of bias and extracted data of included studies. To estimate strategy effectiveness from a single study comparison, we used the median effect size (MES) in the comparison for outcomes in the same outcome group. The primary analysis evaluated each strategy group with a weighted median and interquartile range (IQR) of MES values. In secondary analyses, standard random-effects meta-analysis was used to estimate the weighted mean MES and 95% confidence interval (CI) of the mean MES of each strategy group. This review is registered with PROSPERO (International Prospective Register of Systematic Reviews): CRD42017078108. RESULTS: Twenty-nine studies were included; most (21/29, 72.4%) were interrupted time series studies. Evidence quality was generally low to very low. Among studies involving health facility-based health care providers (HCPs), for "QIC only", effectiveness varied widely across outcome groups and tended to have little effect for patient health outcomes (median MES less than 2 percentage points for percentage and continuous outcomes). For "QIC plus training", effectiveness might be very high for patient health outcomes (for continuous outcomes, median MES 111.6 percentage points, range: 96.0 to 127.1) and HCP practice outcomes (median MES 52.4 to 63.4 percentage points for continuous and percentage outcomes, respectively). The only study of lay HCPs, which used "QIC plus training", showed no effect on patient care-seeking behaviors (MES -0.9 percentage points), moderate effects on non-care-seeking patient behaviors (MES 18.7 percentage points), and very large effects on HCP practice outcomes (MES 50.4 percentage points). CONCLUSIONS: The effectiveness of QICs varied considerably in LMICs. QICs combined with other invention components, such as training, tended to be more effective than QICs alone. The low evidence quality and large effect sizes for QIC plus training justify additional high-quality studies assessing this approach in LMICs. en_US
dc.language.iso eng en_US
dc.publisher Public Library of Science en_US
dc.rights info:eu-repo/semantics/openAccess
dc.rights.uri https://creativecommons.org/licenses/by/2.5/ar/
dc.subject Quality of Health Care en_US
dc.subject Calidad de la Atención de Salud en_US
dc.title The effectiveness of the quality improvement collaborative strategy in low- and middleincome countries: A systematic review and meta-analysis en_US
dc.type info:eu-repo/semantics/publishedVersion
dc.type info:eu-repo/semantics/article en_US
dc.description.fil Fil: Garcia-Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria. Calidad, Seguridad del Paciente y Gestión Clínica; Argentina.
dc.description.fil Fil: Rowe, Samantha Y. Centers for Disease Control and Prevention. Center for Global Health. Division of Parasitic Diseases and Malaria. Malaria Branch; Estados Unidos.
dc.description.fil Fil: Teijeiro, Maria E. Fleni. Servicio de Calidad y Seguridad del Paciente; Argentina.
dc.description.fil Fil: Ciapponi, Agustín. Instituto de Efectividad Clínica y Sanitaria. Centro Cochrane Argentino; Argentina.
dc.description.fil Fil: Rowe, Alexander K. Centers for Disease Control and Prevention. Center for Global Health. Division of Parasitic Diseases and Malaria. Malaria Branch; Estados Unidos.
dc.relation.ispartofVOLUME 14
dc.relation.ispartofNUMBER 10
dc.relation.ispartofCOUNTRY Estados Unidos
dc.relation.ispartofCITY San Francisco
dc.relation.ispartofTITLE PloS one
dc.relation.ispartofISSN 1932-6203
dc.type.snrd info:ar-repo/semantics/artículo es_ES


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