PLOS ONE Publishes IDCAP Facility Performance Results

The International Training and Education Center for Health (I-TECH) is proud to have been a partner on the first randomized trial of educational outreach and continuous quality improvement (CQI) in Africa. The evidence in a new IDCAP Overview article published in PLOS ONE — “Improving Facility Performance in Infectious Disease Care in Uganda: a Mixed Design Study with Pre/Post and Cluster Randomized Trial Components” — by Dr. Marcia Weaver et al. supports I-TECH’s work in three ways:

  1. The pre/post comparisons showed that high quality training, educational outreach, and CQI significantly improved the quality of care for emergencies, malaria, and pneumonia, and enrollment in HIV care.
  1. IDCAP demonstrates I-TECH’s capacity to measure the effects of training and other interventions to improve care and treatment, such as case scenarios/clinical vignettes, clinical observation, facility performance measures, and population-based mortality.
  1. The Overview article reports that efforts to improve data collection had an independent effect on the quality of care for two facility performance indicators. In other words, improving health information systems also serves as an intervention to improve the quality of care. 

“I am grateful for the curriculum development ‘dream team,'” said Dr. Weaver, “including Ann Miceli and Lisa Rayko Farrar from I-TECH, for outstanding implementation by the Infectious Diseases Institute and University Research Co, LLC, and to Accordia Global Health Foundation for project leadership and Sarah Burnett’s excellent data management and analysis.”

The following recap was first published in AccordiaNews, Aug. 26, 2014. 

In a new paper, published today, Professor Marcia Weaver and colleagues report an overview of the findings from the Integrated Infectious Disease Capacity-Building Evaluation (IDCAP).

Accordia Global Health Foundation, with funding from the Bill & Melinda Gates Foundation, launched IDCAP to better equip mid-level practitioners to manage infectious diseases and to advance the global health community’s understanding of the cost-effectiveness of innovative training approaches. IDCAP created a state-of-the-art package of training interventions that incorporated three key elements: 1) a focus on mid-level practitioners, 2) integration across infectious diseases, and 3) on-site support.

The impact of training was tested on three levels: individual clinician capacity and practice, facility performance, and patient health outcomes. Professor Weaver’s article, entitled Improving Facility Performance in Infectious Disease Care in Uganda: a Mixed Design Study with Pre/Post and Cluster Randomized Trial Components, describes the impact of the IDCAP interventions on 23 facility performance indicators.

IDCAP improved the quality of care in several areas with a combination of infectious disease training, on-site team training and mentoring, and quality improvement interventions. The IDCAP interventions resulted in statistically significant improvements in six facility performance indicators related to emergency triage, assessment and treatment (ETAT), malaria diagnosis and treatment, pneumonia assessment, and enrollment in HIV care. However, the on-site support intervention alone, significantly improved performance in only one of the 23 facility indicators.

Kelly Willis, Accordia’s Executive Director and a co-author, explained, “The majority of research in medicine and public health focuses on a single disease and a single outcome, which is often appropriate.  This vertical focus however, may sometimes be to the detriment of professional training and processes of care at a clinic. Accordia is proud to be at the forefront of exploring the integration of training and clinical care.”