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Pesec M, Spigel L, Granados JMM, Bitton A, Hirschhorn LR, Brizuela JAJ, Pignone M, Sáenz MDR, Schwarz D, Villegas Del Carpio O, Wilson IB, Zamora Méndez E, Ratcliffe HL. Strengthening data collection and use for quality improvement in primary care: the case of Costa Rica. Health Policy Plan 2021; 36:740-753. [PMID: 33848340 PMCID: PMC8173660 DOI: 10.1093/heapol/czab043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/23/2021] [Accepted: 03/22/2021] [Indexed: 12/24/2022] Open
Abstract
Costa Rica is a bright spot of primary healthcare (PHC) performance, providing first-contact accessibility and continuous, comprehensive, coordinated, and patient-centered care to its citizens. Previous research hypothesized that strong data collection and use for quality improvement are central to Costa Rica's success. Using qualitative data from 40 interviews with stakeholders across the Costa Rican healthcare system, this paper maps the various data streams at the PHC level and delineates how these data are used to make decisions around insuring and improving the quality of PHC delivery. We describe four main types of PHC data: individual patient data, population health data, national healthcare delivery data, and local supplementary healthcare delivery data. In particular, we find that the Healthcare Delivery Performance Index-a ranking of the nation's 106 Health Areas using 15 quality indicators-is utilized by Health Area Directors to create quality improvement initiatives, ranging from education and coaching to optimization of care delivery and coordination. By ranking Health Areas, the Index harnesses providers' intrinsic motivation to stimulate improvement without financial incentives. We detail how a strong culture of valuing data as a tool for improving population health and robust training for personnel have enabled effective data collection and use. However, we also find that the country's complex data systems create unnecessary duplication and can inhibit efficient data use. Costa Rica's experience with data collection, analysis, and use for quality improvement hold important lessons for PHC in other public sector systems.
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Affiliation(s)
- Madeline Pesec
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, 401 Park Drive, Boston, MA 02215, USA.,Division of General Medicine, Department of Internal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Lauren Spigel
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, 401 Park Drive, Boston, MA 02215, USA
| | - José María Molina Granados
- Department of Quality Assurance, Costa Rican Social Security Administration, Second Avenue between 5th and 7th Street, San José, 10105, Costa Rica
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, 401 Park Drive, Boston, MA 02215, USA.,Division of General Medicine, Department of Internal Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.,Center for Primary Care, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 420 E Superior Street, Chicago, IL 60611, USA
| | | | - Michael Pignone
- Department of Internal Medicine, Dell Medical School University of Texas, 1501 Red River Street, Austin, TX 78712, USA
| | - María Del Rocío Sáenz
- School of Public Health, University of Costa Rica, Calle la Cruz 26, San José, Mercedes, Costa Rica
| | - Dan Schwarz
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, 401 Park Drive, Boston, MA 02215, USA.,Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.,Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Oscar Villegas Del Carpio
- Health Service Delivery Strengthening Department, Costa Rican Social Security Administration, Second Avenue between 5th and 7th Street, San José, 10105, Costa Rica
| | - Ira B Wilson
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA
| | - Eduardo Zamora Méndez
- Costa Rican Social Security Administration, Second Avenue between 5th and 7th Street, San José, 10105, Costa Rica
| | - Hannah L Ratcliffe
- Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, 401 Park Drive, Boston, MA 02215, USA
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Spigel L, Pesec M, Villegas Del Carpio O, Ratcliffe HL, Jiménez Brizuela JA, Madriz Montero A, Zamora Méndez E, Schwarz D, Bitton A, Hirschhorn LR. Implementing sustainable primary healthcare reforms: strategies from Costa Rica. BMJ Glob Health 2021; 5:bmjgh-2020-002674. [PMID: 32843571 PMCID: PMC7449361 DOI: 10.1136/bmjgh-2020-002674] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/14/2022] Open
Abstract
As the world strives to achieve universal health coverage by 2030, countries must build robust healthcare systems founded on strong primary healthcare (PHC). In order to strengthen PHC, country governments need actionable guidance about how to implement health reform. Costa Rica is an example of a country that has taken concrete steps towards successfully improving PHC over the last two decades. In the 1990s, Costa Rica implemented three key reforms: governance restructuring, geographic empanelment, and multidisciplinary teams. To understand how Costa Rica implemented these reforms, we conducted a process evaluation based on a validated implementation science framework. We interviewed 39 key informants from across Costa Rica's healthcare system in order to understand how these reforms were implemented. Using the Exploration Preparation Implementation Sustainment (EPIS) framework, we coded the results to identify Costa Rica's key implementation strategies and explore underlying reasons for Costa Rica's success as well as ongoing challenges. We found that Costa Rica implemented PHC reforms through strong leadership, a compelling vision and deliberate implementation strategies such as building on existing knowledge, resources and infrastructure; bringing together key stakeholders and engaging deeply with communities. These reforms have led to dramatic improvements in health outcomes in the past 25 years. Our in-depth analysis of Costa Rica's specific implementation strategies offers tangible lessons and examples for other countries as they navigate the important but difficult work of strengthening PHC.
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Affiliation(s)
| | - Madeline Pesec
- Ariadne Labs, Boston, Massachusetts, USA.,Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Oscar Villegas Del Carpio
- Health Service Delivery Strengthening Department, Caja Costaricense de Seguro Social, San José, Costa Rica
| | | | | | | | | | - Dan Schwarz
- Ariadne Labs, Boston, Massachusetts, USA.,Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Asaf Bitton
- Ariadne Labs, Boston, Massachusetts, USA.,Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lisa R Hirschhorn
- Ariadne Labs, Boston, Massachusetts, USA .,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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