validation of a new method for testing provider clinical quality in rural settings in low- and middle-income countries the observed simulated patient验证测试提供临床质量的一种新方法在农村设置在低收入和中等收入国家,观察模拟病人.pdfVIP

Validation of a New Method for Testing Provider Clinical Quality in Rural Settings in Low- and Middle-Income Countries: The Observed Simulated Patient 1 2 2 1 2 Tin Aung , Dominic Montagu *, Karen Schlein , Thin Myat Khine , Willi McFarland 1 Research Department, Population Services International, Yangon, Myanmar, 2 Department of Epidemiology, University of California San Francisco, San Francisco, California, United States of America Abstract Background: Assessing the quality of care provided by individual health practitioners is critical to identifying possible risks to the health of the public. However, existing assessment methods can be inaccurate, expensive, or infeasible in many developing country settings, particularly in rural areas and especially for children. Following an assessment of the strengths and weaknesses of the existing methods for provider assessment, we developed a synthesis method combining components of direct observation, clinical vignettes, and medical mannequins which we have termed ‘‘Observed Simulated Patient’’ or OSP. An OSP assessment involves a trained actor playing the role of a ‘mother’, a life-size doll representing a 5- year old boy, and a trained observer. The provider being assessed was informed in advance of the role-playing, and told to conduct the diagnosis and treatment as he normally would while verbally describing the examinations. Methodology/Principal Findings: We tested the validity of OSP by conducting parallel scoring of medical providers in Myanmar, assessing the quality of their diagnosis and treatment of pediatric malaria, first by direct observation of true patients and second by OSP. Data were col