Does an innovative paper-based health information system (PHISICC) improve data quality and use in primary healthcare? Protocol of a multicountry, cluster randomised controlled trial in sub-Saharan African rural settings

INTRODUCTION: Front-line health workers in remote health facilities are the first contact of the formal health sector and are confronted with life-saving decisions. Health information systems (HIS) support the collection and use of health related data. However, HIS focus on reporting and are unfit to support decisions. Since data tools are paper-based in most primary healthcare settings, we have produced an innovative Paper-based Health Information System in Comprehensive Care (PHISICC) using a human-centred design approach. We are carrying out a cluster randomised controlled trial in three African countries to assess the effects of PHISICC compared with the current systems. METHODS AND ANALYSIS: Study areas are in rural zones of Côte d'Ivoire, Mozambique and Nigeria. Seventy health facilities in each country have been randomly allocated to using PHISICC tools or to continuing to use the regular HIS tools. We have randomly selected households in the catchment areas of each health facility to collect outcomes' data (household surveys have been carried out in two of the three countries and the end-line data collection is planned for mid-2021). Primary outcomes include data quality and use, coverage of health services and health workers satisfaction; secondary outcomes are additional data quality and use parameters, childhood mortality and additional health workers and clients experience with the system. Just prior to the implementation of the trial, we had to relocate the study site in Mozambique due to unforeseen logistical issues. The effects of the intervention will be estimated using regression models and accounting for clustering using random effects. ETHICS AND DISSEMINATION: Ethics committees in Côte d'Ivoire, Mozambique and Nigeria approved the trials. We plan to disseminate our findings, data and research materials among researchers and policy-makers. We aim at having our findings included in systematic reviews on health systems interventions and future guidance development on HIS. TRIAL REGISTRATION NUMBER: PACTR201904664660639; Pre-results

How Registries Can Help Performance Measurement Improve Care

Suggests ways to better utilize databases of clinical information to evaluate care processes and outcomes and improve measurements of healthcare quality and costs, comparative clinical effectiveness research, and medical product safety surveillance

All-Payer Claims Database Development Manual: Establishing a Foundation for Health Care Transparency and Informed Decision Making

With support from the Gary and Mary West Health Policy Center, the APCD Council has developed a manual for states to develop all-payer claims databases. Titled All-Payer Claims Database Development Manual: Establishing a Foundation for Health Care Transparency and Informed Decision Making, the manual is a first-of its-kind resource that provides states with detailed guidance on common data standards, collection, aggregation and analysis involved with establishing these databases

Measuring and Improving Health Care Quality for Children in Medicaid and CHIP: A Primer for Child Health Stakeholders

A large body of evidence shows that, compared to low-income uninsured children, Medicaid has been highly successful in providing children with a usual source of care and regular well-child care while significantly reducing unmet or delayed needs for medical care, dental care, and prescription drugs due to costs. Nonetheless, quality improvement centers on the notion that systematic and continuous actions lead to measurable improvement in health care services and health status. To this end, health care quality improvement efforts in Medicaid and the Children's Health Insurance Program (CHIP) have accelerated significantly in the past several years largely due to the CHIP Reauthorization Act of 2009 (CHIPRA) and the Affordable Care Act of 2010 (ACA). In May 2015, the Centers for Medicaid and Medicare Services (CMS) also proposed a major modernization of federal rules regarding Medicaid managed care. If enacted, the regulations will have sweeping implications for state quality strategies that extend to all health care delivery mechanisms, including fee-for-service. Provisions in the new rules call for transparency and for states to engage stakeholders in planning and implementation.Given the acceleration in health care quality improvement and opportunities for stakeholder engagement, this brief is intended as a primer for child health policy and advocacy organizations that want to focus their efforts beyond coverage to ensure that every child enrolled in Medicaid and CHIP receives high quality health care. The goal is to help stakeholders better understand the current state of quality measurement and improvement, specifically as it pertains to children enrolled in Medicaid and CHIP. It covers a brief history of health care quality efforts, explains the basics of quality measurement and improvement, discusses the challenges in data collection and analysis, and describes how quality improvement initiatives work. Importantly, it discusses the key roles that child health policy and advocacy organizations can play in making sure that our public coverage programs for children deliver high quality health care that advances health outcomes and strives for continuous improvement

Monitoring and Assessing the Use of External Quality Review Organizations to Improve Services for Young Children: A Toolkit for State Medicaid Agencies

Assesses the extent to which states use external quality review organizations in studying the quality of preventive and developmental services for young children enrolled in Medicaid, and provides guidance on determining their scope of work

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations

State Strategies to Improve Quality and Efficiency: Making the Most of Opportunities in National Health Reform

Examines ten states' initiatives to address key components of quality and efficiency improvement, including data collection, aggregation, and standardization; public reporting; payment reform; consumer engagement; and provider engagement

HealthCare Partners: Building on a Foundation of Global Risk Management to Achieve Accountable Care

Describes the progress of a medical group and independent practice association in forming an accountable care organization by working with insurers as part of the Brookings-Dartmouth ACO Pilot Program. Lists lessons learned and elements of success

Implementing State Health Reform: Lessons for Policymakers

Drawing on five states' experiences, discusses questions and considerations, including the need to coordinate state agencies' work and share data, simplify eligibility and enrollment procedures, and involve community groups and businesses in outreach