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PRIME II. Consumer Driven Quality in the Dominican Republic. 10 Steps of DRCDQ Strategy. Step 1 : Stakeholder meetings held with ADOPLAFAM (NGO) definition of priorities and consumer target groups (consumers who can pay for services)

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PRIME II

Consumer Driven Quality in the Dominican Republic


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10 Steps of DRCDQ Strategy

  • Step 1: Stakeholder meetings held with ADOPLAFAM (NGO) definition of priorities and consumer target groups (consumers who can pay for services)

  • Step 2: Meetings with community leaders in 5 target areas


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10 Steps of DRCDQ (cont.)

  • Step 3: Participatory Group Activities using COPE methodologies

    Community Representatives elected

  • Step 4: Results of community activities presented to clinic

  • Step 5: Clinic Action Plan (CAP) defined and presented to community reps


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10 Steps of DRCDQ (cont.)

  • Step 6: Continued Meetings between clinic staff and Community to follow up on clinic action plan

    Decision to organize community talks with clinic doctors in target areas.

    Decision to train community representatives and promoters on how to document consumer opinion in tools designed by PRIME and ADOPLAFAM


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10 Steps of DRCDQ (cont.)

  • Step 7: Community talks field testing tool to document consumer opinion

  • Step 8: Community representatives trained to use quality of care interviews during home visits

  • Step 9: Doctors and promoters share learned information with staff

  • Step 10: IMPROVED QUALITY OF CARE!!



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WHO IS INVOLVED IN THE EVALUATION?

  • Clinic staff

  • Clinic community promoters

  • Consumers


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How are we evaluating?

  • Client exit interviews

  • Clinical observations

  • Promoter Observations

  • Provider Interviews

  • Focus Groups (February 2003)


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What are our process indicators?

  • Number and type of services used by clients with coupons

  • Number and type of services used by clients without coupons

  • Number, sex, and age of clients seeking services at clinic

  • Number of problems identified and solved by the clinic quality team

  • Number of meetings held between community members and clinic staff


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In 32 client exit surveys:

72% of clients interviewed were satisfied with the services they received

50% felt that the clinic offered the services they needed

97% felt they were able to talk without interruptions

In 11 provider observations:

40% of providers explained what would happen in the medical exam

20% of providers allowed the patient to talk without interrupting her

20% of providers asked what the motive of the patient´s visit was

12.5% of providers asked if the patient had any questions and to express her opinions

BASELINE RESULTS


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BASELINE RESULTS

  • In 49 promoter observations:

  • 2% registered their visit, the results of the visit, and made a follow-up plan

  • 35% asked if the woman had been to the clinic

  • 10% asked those who had been to the clinic what they thought of the clinic services


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Process Indicator Results to Date

  • Clinic Action Plan Completed

  • 8 meetings between clinic and community members at clinic to discuss importance of community input, discuss how community members want to give input to clinic, and review action plan

  • 6 talks given on community requested topics by 4 different clinic providers in community

  • 27 Community promoters and representatives trained on needs and quality assessment interview


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Need more privacy

Television with education videos in waiting room

More awareness building on clinic services

Child immunization

Clear signs identifying clinic

Need for place to give birth/stay overnight

Good treatment by staff

Clean and hygienic environment

Summary of CDQ/quality improvement action plan


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Some preliminary Output indicators

  • Increase in number of paying clients:

    • Income from paid services in the clinic have increased from $22,646 in January to $43,209 in August.

    • In December of 2001, the ratio of paying clients to non-paying clients was 28%/72% In August of 2002, the ratio was 83%/13%.

  • Increase in number of clients:

    • Between October-December 2001, 956 clients attended the clinic. By October-December 2002, this number increased to 1925.


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    Output Indicators (cont.)

    Increase in number of services

    • 2 more gynecologists (one female) added*

    • Addition of 3 full days of gynecology (at the baseline, the one gynecologist only worked two days a week)

    • Addition of 3 hours of pediatric attention

    • Addition of a cardiologist*

    • Addition of a 2 psychologists*

    • Addition of 6 hours of sonograms

    • Addition of Radiology 5 days a week


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    Next steps (project ends June 2003.)

    • Continued field monitoring of the model for increasing community input, revise tool according to findings.

    • Continue community talks by providers

    • Continue meetings between community representatives and clinic staff.

    • Promoters and representatives to continue testing tool

    • Document changes in quality of care

    • Video document process

    • Final Evaluation-April 2003


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