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Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda.
PLOS ONE ( IF 2.9 ) Pub Date : 2018-03-16 , DOI: 10.1371/journal.pone.0194187 Anatole Manzi 1, 2 , Jean Claude Mugunga 2 , Hari S Iyer 2, 3, 4 , Hema Magge 3, 5 , Fulgence Nkikabahizi 6 , Lisa R Hirschhorn 2, 3, 7, 8
PLOS ONE ( IF 2.9 ) Pub Date : 2018-03-16 , DOI: 10.1371/journal.pone.0194187 Anatole Manzi 1, 2 , Jean Claude Mugunga 2 , Hari S Iyer 2, 3, 4 , Hema Magge 3, 5 , Fulgence Nkikabahizi 6 , Lisa R Hirschhorn 2, 3, 7, 8
Affiliation
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BACKGROUND
Integrated management of childhood illness (IMCI) can reduce under-5 morbidity and mortality in low-income settings. A program to strengthen IMCI practices through Mentorship and Enhanced Supervision at Health centers (MESH) was implemented in two rural districts in eastern Rwanda in 2010.
METHODS
We estimated cost per improvement in quality of care as measured by the difference in correct diagnosis and correct treatment at baseline and 12 months of MESH. Costs of developing and implementing MESH were estimated in 2011 United States Dollars (USD) from the provider perspective using both top-down and bottom-up approaches, from programmatic financial records and site-level data. Improvement in quality of care attributed to MESH was measured through case management observations (n = 292 cases at baseline, 413 cases at 12 months), with outcomes from the intervention already published. Sensitivity analyses were conducted to assess uncertainty under different assumptions of quality of care and patient volume.
RESULTS
The total annual cost of MESH was US$ 27,955.74 and the average cost added by MESH per IMCI patient was US$1.06. Salary and benefits accounted for the majority of total annual costs (US$22,400 /year). Improvements in quality of care after 12 months of MESH implementation cost US$2.95 per additional child correctly diagnosed and $5.30 per additional child correctly treated.
CONCLUSIONS
The incremental costs per additional child correctly diagnosed and child correctly treated suggest that MESH could be an affordable method for improving IMCI quality of care elsewhere in Rwanda and similar settings. Integrating MESH into existing supervision systems would further reduce costs, increasing potential for spread.
中文翻译：
对指导进行经济评估并加强监督计划，以提高卢旺达农村地区儿童疾病护理综合管理的质量。
背景技术儿童疾病的综合管理（IMCI）可以降低低收入人群中5岁以下儿童的发病率和死亡率。2010年，在卢旺达东部的两个农村地区实施了一项通过指导和加强卫生中心监督（MESH）加强IMCI实践的计划。方法我们根据正确诊断和正确治疗的差异来估算每项护理质量改善的成本。在基线和MESH的12个月。从供应商的角度，使用自上而下和自下而上的方法，从计划财务记录和站点级别数据中，估计开发和实施MESH的成本以2011年美元（USD）为单位。通过病例管理观察评估了归因于MESH的护理质量的改善（基线时n = 292例，在12个月时413例），已经发表的干预措施的结果。进行敏感性分析以评估在不同护理质量和患者数量的假设下的不确定性。结果MESH的年度总费用为27,955.74美元，每名IMCI患者的MESH平均增加的费用为1.06美元。工资和福利占年度总成本的大部分（22,400美元/年）。实施MESH 12个月后，护理质量的提高使每名正确诊断出的儿童花费2.95美元，每名正确接受治疗的儿童花费5.30美元。结论正确诊断每增加一名儿童和正确治疗一名儿童所产生的增量费用表明，MESH可以成为改善卢旺达其他地区和类似环境的IMCI护理质量的负担得起的方法。
更新日期：2018-03-17
中文翻译：
对指导进行经济评估并加强监督计划，以提高卢旺达农村地区儿童疾病护理综合管理的质量。
背景技术儿童疾病的综合管理（IMCI）可以降低低收入人群中5岁以下儿童的发病率和死亡率。2010年，在卢旺达东部的两个农村地区实施了一项通过指导和加强卫生中心监督（MESH）加强IMCI实践的计划。方法我们根据正确诊断和正确治疗的差异来估算每项护理质量改善的成本。在基线和MESH的12个月。从供应商的角度，使用自上而下和自下而上的方法，从计划财务记录和站点级别数据中，估计开发和实施MESH的成本以2011年美元（USD）为单位。通过病例管理观察评估了归因于MESH的护理质量的改善（基线时n = 292例，在12个月时413例），已经发表的干预措施的结果。进行敏感性分析以评估在不同护理质量和患者数量的假设下的不确定性。结果MESH的年度总费用为27,955.74美元，每名IMCI患者的MESH平均增加的费用为1.06美元。工资和福利占年度总成本的大部分（22,400美元/年）。实施MESH 12个月后，护理质量的提高使每名正确诊断出的儿童花费2.95美元，每名正确接受治疗的儿童花费5.30美元。结论正确诊断每增加一名儿童和正确治疗一名儿童所产生的增量费用表明，MESH可以成为改善卢旺达其他地区和类似环境的IMCI护理质量的负担得起的方法。
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