A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact

BACKGROUND

The growing adoption of continuous quality improvement (CQI) initiatives in healthcare has generated a surge in research interest to gain a deeper understanding of CQI. However, comprehensive evidence regarding the diverse facets of CQI in healthcare has been limited. Our review sought to comprehensively grasp the conceptualization and principles of CQI, explore existing models and tools, analyze barriers and facilitators, and investigate its overall impacts.

METHODS

This qualitative scoping review was conducted using Arksey and O'Malley's methodological framework. We searched articles in PubMed, Web of Science, Scopus, and EMBASE databases. In addition, we accessed articles from Google Scholar. We used mixed-method analysis, including qualitative content analysis and quantitative descriptive for quantitative findings to summarize findings and PRISMA extension for scoping reviews (PRISMA-ScR) framework to report the overall works.

RESULTS

A total of 87 articles, which covered 14 CQI models, were included in the review. While 19 tools were used for CQI models and initiatives, Plan-Do-Study/Check-Act cycle was the commonly employed model to understand the CQI implementation process. The main reported purposes of using CQI, as its positive impact, are to improve the structure of the health system (e.g., leadership, health workforce, health technology use, supplies, and costs), enhance healthcare delivery processes and outputs (e.g., care coordination and linkages, satisfaction, accessibility, continuity of care, safety, and efficiency), and improve treatment outcome (reduce morbidity and mortality). The implementation of CQI is not without challenges. There are cultural (i.e., resistance/reluctance to quality-focused culture and fear of blame or punishment), technical, structural (related to organizational structure, processes, and systems), and strategic (inadequate planning and inappropriate goals) related barriers that were commonly reported during the implementation of CQI.

CONCLUSIONS

Implementing CQI initiatives necessitates thoroughly comprehending key principles such as teamwork and timeline. To effectively address challenges, it's crucial to identify obstacles and implement optimal interventions proactively. Healthcare professionals and leaders need to be mentally equipped and cognizant of the significant role CQI initiatives play in achieving purposes for quality of care.

Incidence and factors associated with outcomes of uterine rupture among women delivered at Felegehiwot referral hospital, Bahir Dar, Ethiopia: cross sectional study

Background

Maternal mortality is a major public health challenge in Ethiopia. Uterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. Uterine rupture has been contributing to high maternal morbidity and mortality. However, there is limited research on the factors and management outcomes of women with uterine rupture. Understanding the factors and management outcomes might delineate strategies to support survivors. Therefore the aim of this study is to assess the incidence and factors associated with outcomes of uterine rupture among laboring mothers at Felegehiwot Referral Hospital in Bahir Dar City, Northwest Ethiopia.

Methods

This is a cross sectional study with retrospective facility based data collection technique. All pregnant women who were managed for ruptured uterus at Felegehiwot referral hospital from September 11 2012 to August 30 2017 were included. The chart numbers of the women collected from operation theatre registers. Their case folders retrieved from the medical records room for analysis. Using structured check list, information on their sociodemography, booking status, clinical features at presentation and the place of attempted vaginal delivery was extracted. Data on the intraoperative findings, treatment, and associated complications and outcomes also collected. The collected data cleaned, coded and entered into EPI- Info version (7.1.2.0) and then exported in to SPSS Version 20.0 for analysis. Statistical comparison was done using chi square (X²). Strength of association between the explanatory variables and outcome variables described using odds ratio at 95% CI and P value less than 0.05. The results presented in tables.

Results

We studied 239 cases of uterine rupture in the 5 years period. Mothers without previous cesarean delivery including eight primigravidas took 87% of the cases. From all study participants, 54 of mothers (22.6%) developed undesired outcomes whereas 185(77.4%) discharged without major sequel. More than half (56.9%) arrived in hypovolemic shock. Total abdominal hysterectomy was the commonest procedure accounting for 61.5%. Duration of surgery was less than 2 h in 67.8% of the procedures. Anemia is the commonest complication (80.3%) followed by wound infection and VVF (11.7% each). There were 5 maternal deaths (2.1%). Mothers who had prolonged operation time (> 2 h) (AOR: 2.2, 95% CI: 1.10, 4.63) were significantly associated with undesired maternal outcomes after management of uterine rupture.

Conclusion

Incidence of ruptured uterus and its complications were high in the study area. It reflects the need for improvement in obstetric care and strong collaboration with referring health facilities to ensure prompt referral and management.

Risks for STIs/HIV infection among Madawalabu university students, Southeast Ethiopia: a cross sectional study

INTRODUCTION

In developing nations, the spread of STIs/HIV infection continues to affect millions of young and productive population. In Ethiopia youths including university/college students are at greater risk of STIs including HIV infection often due to many risky sexual behaviors. Although there are some anecdotal evidences suggesting widespread unsafe sexual practices among university students, the paucity of research finding, especially in newly established public universities are the major bottle necks to commence feasible interventions. Therefore, this study was designed to assess the magnitudes and factors associated with risks for STIs/HIV infections among Madawalabu university students in Southeast Ethiopia.

METHODOLOGY

An institution based cross sectional study was conducted from May-June 2012. A total of 390 students were selected using stratified then simple random sampling method. Descriptive statistics, binary logistic and multivariable logistic regression analyses were employed to identify factors associated with risks for STIs/HIV infection.

RESULT

Combined risk measure showed that 51.4% of students were at risk of having STIs and/or HIV infection. Practicing casual sex/sex for benefits with first sexual partner (OR = 3.9[95%C.I: 1.86-8.03]), life time multiple sexual partner (had more than three sexual partners) (OR = 2.7[95%C.I: 1.13-6.28]), and number of sexual partners in the last 12 months (four and above) (OR = 4.8[95%C.I: 1.77-13.53]) showed statistically significant association with risks for STIs and/or HIV infection. Practicing casual sex/ sex for any benefit with their first sexual partner (AOR = 3.9 [95%CI: 1.80-8.50]) and multiple sexual partners in the last 12 months (four and above) (AOR = 3.7 [95%C.I: 1.15-11.80]) were found to be the independent predictors of risks for STIs and/or HIV infection.

CONCLUSION

This study has identified risks and risk sexual behaviors for STIs and/or HIV infection on university students. The knowledge of the students towards STIs and/or HIV is unsatisfactory. More than half of the students were at risk for STIs and/or HIV infection. Casual/benefit based sexual relationship with first sexual partner and having multiple sexual partners (≥4 sexual partners) in the last 12 months were independent predictors of STIs and/or HIV infections. Therefore, university based, risk reduction and behavior change focused interventions are recommended.