Breaking barriers: assessing the impact of clinical quality improvements on reducing health disparities in hypertension care among Mumbai's urban slums.

IF 1.3 Q4 HEALTH CARE SCIENCES & SERVICES
Shang Ju Li, Thomas Miles, Itisha Vasisht, Harshwardhan Dere, Celestina Agyekum, Rashad Massoud
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Abstract

The clinical quality improvement initiatives, led by the organisation's Health Equity Working Group (HEWG), aim to support healthcare providers to provide equitable, quality hypertension care worldwide. After coordinating with the India team, we started monitoring the deidentified patient data collected through electronic health records between January and May 2021. After stratifying data by age, sex and residence location, the team found an average of 55.94% of our hypertensive patients control their blood pressure, with an inequity of 11.91% between male and female patients.The objective of this study was to assess the effectiveness of using clinical quality improvement to improve hypertension care in the limited-resourced, mobile healthcare setting in Mumbai slums. We used the model for improvement, developed by Associates in Process Improvement. After 9-month Plan-Do-Study-Act (PDSA) cycles, the average hypertensive patients with controlled blood pressure improved from 55.94% to 89.86% at the endpoint of the initiative. The gender gap reduced significantly from 11.91% to 2.19%. We continued to monitor the blood pressure and found that the average hypertensive patients with controlled blood pressure remained stable at 89.23% and the gender gap slightly increased to 3.14%. Hypertensive patients have 6.43 times higher chance of having controlled blood pressure compared with the preintervention after the 9-month intervention (p<0.001).This paper discusses the efforts to improve hypertension care and reduce health inequities in Mumbai's urban slums. We highlighted the methods used to identify and bridge health inequity gaps and the testing of PDSA cycles to improve care quality and reduce disparities. Our findings have shown that clinical quality improvement initiatives and the PDSA cycle can successfully improve health outcomes and decrease gender disparity in the limited-resource setting.

打破障碍:评估临床质量改进对减少孟买城市贫民窟高血压护理中的健康差异的影响。
临床质量改进计划由该组织的健康公平工作组(HEWG)领导,旨在支持医疗服务提供者在全球范围内提供公平、优质的高血压护理。在与印度团队协调后,我们开始监测 2021 年 1 月至 5 月间通过电子健康记录收集的去身份化患者数据。在按年龄、性别和居住地对数据进行分层后,团队发现我们的高血压患者中平均有 55.94% 的人控制住了血压,男性和女性患者之间的不平等比例为 11.91%。这项研究的目的是评估在孟买贫民窟资源有限的流动医疗环境中利用临床质量改进改善高血压护理的有效性。我们采用了流程改进协会开发的改进模型。经过 9 个月的 "计划-实施-研究-行动"(PDSA)周期后,血压得到控制的高血压患者平均比例从 55.94% 提高到计划终点时的 89.86%。性别差距从 11.91% 显著降至 2.19%。我们继续监测血压,发现血压得到控制的高血压患者的平均血压稳定在 89.23%,性别差距略微增加到 3.14%。在为期 9 个月的干预后,高血压患者血压得到控制的几率比干预前高 6.43 倍(P<0.05)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Open Quality
BMJ Open Quality Nursing-Leadership and Management
CiteScore
2.20
自引率
0.00%
发文量
226
审稿时长
20 weeks
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