PMID- 22776745
OWN - NLM
STAT- MEDLINE
DCOM- 20121116
LR  - 20220309
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 12
DP  - 2012 Jul 9
TI  - Improving data quality and supervision of antiretroviral therapy sites in Malawi: 
      an application of Lot Quality Assurance Sampling.
PG  - 196
LID - 10.1186/1472-6963-12-196 [doi]
AB  - BACKGROUND: High quality program data is critical for managing, monitoring, and 
      evaluating national HIV treatment programs. By 2009, the Malawi Ministry of 
      Health had initiated more than 270,000 patients on HIV treatment at 377 sites. 
      Quarterly supervision of these antiretroviral therapy (ART) sites ensures high 
      quality care, but the time currently dedicated to exhaustive record review and 
      data cleaning detracts from other critical components. The exhaustive record 
      review is unlikely to be sustainable long term because of the resources required 
      and increasing number of patients on ART. This study quantifies the current 
      levels of data quality and evaluates Lot Quality Assurance Sampling (LQAS) as a 
      tool to prioritize sites with low data quality, thus lowering costs while 
      maintaining sufficient quality for program monitoring and patient care. METHODS: 
      In January 2010, a study team joined supervision teams at 19 sites purposely 
      selected to reflect the variety of ART sites. During the exhaustive data review, 
      the time allocated to data cleaning and data discrepancies were documented. The 
      team then randomly sampled 76 records from each site, recording secondary 
      outcomes and the time required for sampling. RESULTS: At the 19 sites, only 1.2% 
      of records had discrepancies in patient outcomes and 0.4% in treatment regimen. 
      However, data cleaning took 28.5 hours in total, suggesting that data cleaning 
      for all 377 ART sites would require over 350 supervision-hours quarterly. The 
      LQAS tool accurately identified the sites with the low data quality, reduced the 
      time for data cleaning by 70%, and allowed for reporting on secondary outcomes. 
      CONCLUSIONS: Most sites maintained high quality records. In spite of this, data 
      cleaning required significant amounts of time with little effect on program 
      estimates of patient outcomes. LQAS conserves resources while maintaining 
      sufficient data quality for program assessment and management to allow for 
      quality patient care.
FAU - Hedt-Gauthier, Bethany L
AU  - Hedt-Gauthier BL
AD  - Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA. 
      bethhedt@gmail.com
FAU - Tenthani, Lyson
AU  - Tenthani L
FAU - Mitchell, Shira
AU  - Mitchell S
FAU - Chimbwandira, Frank M
AU  - Chimbwandira FM
FAU - Makombe, Simon
AU  - Makombe S
FAU - Chirwa, Zengani
AU  - Chirwa Z
FAU - Schouten, Erik J
AU  - Schouten EJ
FAU - Pagano, Marcello
AU  - Pagano M
FAU - Jahn, Andreas
AU  - Jahn A
LA  - eng
GR  - T32 AI007358/AI/NIAID NIH HHS/United States
GR  - R01 AI097015/AI/NIAID NIH HHS/United States
GR  - R01 EB006195/EB/NIBIB NIH HHS/United States
GR  - P30 AI060354/AI/NIAID NIH HHS/United States
GR  - AI097015/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20120709
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
RN  - 0 (Anti-Retroviral Agents)
SB  - IM
MH  - Anti-Retroviral Agents/*therapeutic use
MH  - Benchmarking
MH  - Certification
MH  - Cost of Illness
MH  - HIV Infections/*drug therapy
MH  - Humans
MH  - *Lot Quality Assurance Sampling
MH  - Malawi
MH  - Organization and Administration
MH  - Patient Care Team/organization & administration
MH  - Private Sector/standards
MH  - Program Evaluation
MH  - Public Sector/standards
MH  - Quality Assurance, Health Care/*standards
MH  - Reproducibility of Results
MH  - Time Factors
MH  - *Total Quality Management
MH  - Treatment Outcome
PMC - PMC3411464
EDAT- 2012/07/11 06:00
MHDA- 2012/12/10 06:00
PMCR- 2012/07/09
CRDT- 2012/07/11 06:00
PHST- 2012/01/12 00:00 [received]
PHST- 2012/07/09 00:00 [accepted]
PHST- 2012/07/11 06:00 [entrez]
PHST- 2012/07/11 06:00 [pubmed]
PHST- 2012/12/10 06:00 [medline]
PHST- 2012/07/09 00:00 [pmc-release]
AID - 1472-6963-12-196 [pii]
AID - 10.1186/1472-6963-12-196 [doi]
PST - epublish
SO  - BMC Health Serv Res. 2012 Jul 9;12:196. doi: 10.1186/1472-6963-12-196.