Quality of care is a priority for U.S. Agency for International Development (USAID). The agency's missions abroad and their host country partners work in quality improvement, but a lack of evidence about the best ways to facilitate such improvements has constrained their informed selection of interventions. Six different methods - accreditation, COPE, improvement collaborative, standards-based management and recognitions (SBM-R), supervision, and clinical in-service training - currently make up the majority of this investment for USAID missions. As their already substantial investment in quality grows, there is demand for more scientific evidence on how to reliably improve quality of care in poor countries. USAID missions, and many other organizations spending on quality improvement, would welcome more information about how different strategies work to improve quality, when and where certain tools are most effective, and the best ways to measure success and shortcomings.

To gain a better understanding of the evidence supporting different quality improvement tools and clarity on how they would help advance the global quality improvement agenda, the Institute of Medicine convened a 2-day workshop in January 2015. The workshop's goal was to illuminate these different methods, discussing their pros and cons. This workshop summary is a description of the presentations and discussions.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• PLANNING COMMITTEE FOR THE WORKSHOP ON IMPROVING QUALITY OF CARE IN LOW- AND MIDDLE-INCOME COUNTRIES
• Reviewers
• Acknowledgments
• Acronyms and Abbreviations
• 1. Introduction
• 2. An Overview of Quality of Care in Low- and Middle-Income Countries
  • KEYNOTE REMARKS
  • USAID'S WORK IN QUALITY OF CARE
• 3. Six Widely Used Methods to Improve Quality
  • THEORIES OF CHANGE
  • TOOLS AND PROCESSES FOR QUALITY IMPROVEMENT
• 4. Reviewing the Evidence for Different Quality Improvement Methods
  • WHAT WORKS?: THE RESULTS OF A SYSTEMATIC REVIEW
  • HOW DO WE KNOW IT WORKS?: MEASURING CHANGES IN QUALITY
  • AT WHAT COST?: WHAT MAKES A PROGRAM COST-EFFECTIVE
  • CLOSING REMARKS
• 5. Synthesizing Evidence, Identifying Gaps
• 6. Cross-Cutting Approaches to Improve Quality
  • PRACTICE TO IMPROVE QUALITY: HOW TO ACCELERATE PROGRESS
  • POLICY TO IMPROVE QUALITY: HOW TO CREATE AN ENVIRONMENT TO IMPROVE QUALITY
  • RESEARCH TO IMPROVE QUALITY: HOW TO ADVANCE THE FIELD
  • REACTIONS TO THE WORKSHOP
  • CLOSING REMARKS
• References
• Appendixes
  • Appendix A. Workshop Agenda
  • Appendix B. Participant Biographies

Rapporteurs: Gillian J. Buckley and Rachel E. Pittluck.

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2015. Improving quality of care in low- and middle-income countries: Workshop summary. Washington, DC: The National Academies Press.