Browsing by Author "Miller, James S."

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    A Cross-Sectional Study Comparing Case Scenarios and Record Review to Measure Quality of Integrated Community Case Management Care in Western Uganda
    (Transactions of the Royal Society of Tropical Medicine and Hygiene, 2021) Miller, James S.; Mbusa, Rapheal Kisolhu; Baguma, Stephen; Patel, Palka; Matte, Michael; Ntaro, Moses; Wesuta, Andrew Christopher; Mumbere, Nobert; Bwambale, Shem; McCarthy, Sara Mian; Kenney, Jessica; Guiles, Daniel; Mulogo, Edgar Mugema; Stone, Geren S.
    In Integrated Community Case Management (iCCM), village health workers (VHW) assess and treat malaria, pneumonia and diarrhea using a clinical algorithm. Study objectives included: 1) Compare VHWs’ performance on case scenario exercises to record review data; 2) assess impact of formal education on performance in the case scenario exercises.36 VHWs in Bugoye Subcounty, Uganda completed the case scenarios exercise, which included video case scenarios and brief oral case vignettes, between July 2017 and February 2018. We obtained clinical records for all iCCM encounters in the same time period.In the video case scenarios, 45% of mock patients received all correct management steps (including all recommended education), while 94% received all critical management steps. Based on the level of data available from record review, 74% of patients in the record review dataset received overall correct management compared to 94% in the video case scenarios. In the case scenarios, VHWs with primary school education performed similarly to those with some or all secondary school education.The case scenarios produced higher estimates of quality of care than record review. VHWs often omitted recommended health education topics in the case scenarios. Level of formal education did not appear to influence performance in the case scenarios.
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    Long-term quality of integrated community case management care for children in Bugoye Subcounty, Uganda: a retrospective observational study
    (BMJ open, 2022) Miller, James S.; Mulogo, Edgar Mugema; Wesuta, Andrew Christopher; Mumbere, Nobert; Mbaju, Jackson; Bwambale, Shem; Stone, Geren S.
    Integrated community case management (iCCM) of childhood illness in Uganda involves protocol-based care of malaria, pneumonia and diarrhoea for children under 5 years old. This study assessed volunteer village health workers’ (VHW) ability to provide correct iCCM care according to the national protocol and change in their performance over time since initial training. VHWs affiliated with the Ugandan national programme provide community-based care in eight villages in Bugoye Subcounty, a rural area in Kasese District. The first cohort of VHWs began providing iCCM care in March 2013, the second cohort in July 2016. All children receiving iCCM care in 18 430 clinical encounters occurring between April 2014 and December 2018. The descriptive primary outcome measure was the proportion of patients receiving overall correct care, defined as adherence to the iCCM protocol for the presenting condition (hereafter quality of care). The analytic primary outcome was change in the odds of receiving correct care over time, assessed using logistic regression models with generalised estimating equations. Secondary outcome measures included a set of binary measures of adherence to specific elements of the iCCM protocol. Preplanned and final measures were the same. Overall, VHWs provided correct care in 74% of clinical encounters. For the first cohort of VHWs, regression modelling demonstrated a modest increase in quality of care until approximately 3 years after their initial iCCM training (OR 1.022 per month elapsed, 95% CI 1.005 to 1.038), followed by a modest decrease thereafter (OR 0.978 per month, 95% CI 0.970 to 0.986). For the second cohort, quality of care was essentially constant over time (OR 1.007 per month, 95% CI 0.989 to 1.025). Quality of care was relatively constant over time, though the trend towards decreasing quality of care after 3 years of providing iCCM care requires further monitoring.