a multifaceted intervention to improve the quality of care of children in district hospitals in kenya a cost-effectiveness analysis多方面的干预来改善医疗服务的质量的儿童区医院在肯尼亚一个成本效益分析.pdfVIP

A Multifaceted Intervention to Improve the Quality of Care of Children in District Hospitals in Kenya: A Cost- Effectiveness Analysis 1,2 1 2 1,3 Edwine W. Barasa *, Philip Ayieko , Susan Cleary , Mike English 1 Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Research – Coast, and Wellcome Trust Research Programme, Nairobi, Kenya, 2 Health Economics Unit, University of Cape Town, Cape Town, South Africa, 3 Department of Pediatrics, University of Oxford, Oxford, United Kingdom Abstract Background: To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+) strategy. We assessed the cost effectiveness of the ETAT+ strategy, in Kenyan hospitals. Further, we estimate the costs of scaling up the intervention to Kenya nationally and potential cost effectiveness at scale. Methods and Findings: Our cost-effectiveness analysis from the provider’s perspective used data from a previously reported cluster randomized trial comparing the full ETAT+ strategy (n = 4 hospitals) with a partial intervention (n = 4 hospitals). Effectiveness was measured using 14 process measures that capture improvements in quality of care; their average was used as a summary measure of quality. Economic costs of the development and implementation of the intervention were determined (2009 US$). Incremental cost-effectiveness ratios were defined as the incremental cost per percentage improvement in (average) quality of care. Probabilistic sensitivity analysis was used to assess uncertainty. The cos