The use of routine case record data to evaluate quality of inpatient hospital care for newborns and children in Kenya

Quality of care assessment is one of the ways of evaluating what the health system is providing and can allow monitoring and evaluation exercises to track progress and identify gaps. Such monitoring however depends on an ability to measure quality with the availability of high quality data being central to these assessments. In low-resource settings routine health or hospital information system data are very limited, often of poor quality, and are typically summarized (e.g. total cases per ward) before being entered into the national health information system database. Such routine data very rarely include any information on a patient’s clinical findings or treatment. Thus at present routine data that are collected do not provide for individual patient level analyses of the process of care.
The work presented in this PhD thesis seeks to demonstrate how case record data may be used to evaluate quality of care in routine hospital settings in Kenya and by doing this promote the availability of quality data and its effective use as one means to promote improvement in services provided in Kenyan hospitals. This work provides important insights into whether hospitalized children and newborns are receiving the correct care are using process of care assessments conducted in relatively large numbers of cases, across multiple locations and across time. I also explore how variable both the processes and outcomes of care may be across settings and examine the associations of this variability using more advanced statistical methods including hierarchical modelling.