Examining which clinicians provide admission hospital care in a high mortality setting and their adherence to guidelines: an observational study in 13 hospitals

ABSTRACT

Arch Dis Child

BACKGROUND: We explored who actually provides most admission care in hospitals offering supervised experiential training to graduating clinicians in a high mortality setting where practices deviate from guideline recommendations. METHODS: We used a large observational data set from 13 Kenyan county hospitals from November 2015 through November 2018 where patients were linked to admitting clinicians. We explored guideline adherence after creating a cumulative correctness of Paediatric Admission Quality of Care (cPAQC) score on a 5-point scale (0-4) in which points represent correct, sequential progress in providing care perfectly adherent to guidelines comprising admission assessment, diagnosis and treatment. At the point where guideline adherence declined the most we dichotomised the cPAQC score and used multilevel logistic regression models to explore whether clinician and patient-level factors influence adherence. RESULTS: There were 1489 clinicians who could be linked to 53 003 patients over a period of 3 years. Patients were rarely admitted by fully qualified clinicians and predominantly by preregistration medical officer interns (MOI, 46%) and diploma level clinical officer interns (COI, 41%) with a median of 28 MOI (range 11-68) and 52 COI (range 5-160) offering care per study hospital. The cPAQC scores suggest that perfect guideline adherence is found in Ogero, M., Akech, S., Malla, L., Agweyu, A., Irimu, G., English, M., Clinical Information Network Author, Group

Pages:648-654, Volume:105, Edition:3/15/2020, Date,Jul

Link: https://www.ncbi.nlm.nih.gov/pubmed/32169853

Notes:Ogero, Morris|Akech, Samuel|Malla, Lucas|Agweyu, Ambrose|Irimu, Grace|English, Mike|eng|WT_/Wellcome Trust/United Kingdom|097170/WT_/Wellcome Trust/United Kingdom|207522/WT_/Wellcome Trust/United Kingdom|MR/R006083/1/MRC_/Medical Research Council/United Kingdom|Observational Study|Research Support, Non-U.S. Gov’t|England|2020/03/15 06:00|Arch Dis Child. 2020 Jul;105(7):648-654. doi: 10.1136/archdischild-2019-317256. Epub 2020 Mar 12.

ISBN: 1468-2044 (Electronic)|0003-9888 (Linking) Permanent ID: PMC7361020 Accession Number: 32169853

Author Address: Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya mogero@kemri-wellcome.org.|School of Mathematics, University of Nairobi College of Biological and Physical Sciences, Nairobi, Kenya.|Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.|Pediatrics, University of Nairobi, Nairobi, Kenya.|Nuffield Department of Medicine, University of Oxford, Oxford, UK.

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