The study of quality assurance of the NCD (non-communicable disease) clinics of the hospitals in the upper south in fiscal year 2014-2016

Abstract

The study of quality assurance of the NCD (non-communicable disease) Clinics of the hospitals in the upper south region was conducted during the fiscal year 2014-2016. This cross-sectional explanatory study aimed to compare the results of self-assessment scores with the results of assessment performed by Health Zone 11 assessment team as part of quality assurance program, as well as problems and success factors using questionnaires and interviews. The target groups are regional hospital (level A), general hospital (S, M) and community hospital (F1-F3) in the upper south region of Thailand. Study methods included self-assessment by participating hospitals and assessments performed by Health Zone 11 assessment team according to the NCD Quality Clinical Criteria. Regional hospitals (level A) were assessed in 2014 and in 2014, 2015, and 2016 community hospitals (F1-F3) were randomly evaluated at the coverage rate of 30, 40, and 30 percent, respectively. Data was analyzed using descriptive statistics including frequency, percentage, mean, and standard deviation. Inferential statistics was also utilized, which included independent sample t-test and Mann-Whitney U test using SPSS software platform. Qualitative analysis involving content analysis was utilized to analyze each component of the six criteria for quality NCD clinic. Additionally, gap analysis was performed to identify areas of improvement and development of the NCD Quality Clinics. Findings from this study indicated that most hospitals under the F1, F2, F3, M1, M2 categories have achieved excellent scores. In the meantime, level A and S hospitals have largely obtained a very good rating as well. Comparison of mean scores between self-assessment and clinical assessment of NCD quality assurance program in fiscal year 2014-2016 found statistically significant difference in p<0.01. Regarding the problems and obstacles, it was found that even though most health care workers responsible for chronic non-communicable diseases (NCDs) have had proper understanding of the guidelines and assessment criteria, there remain some issues that may not be mutually understood in the same way with the appraiser. Findings from this study suggested that successful implementation of the program relied primarily on the commitment of the leadership of health facilities to the quality NCD clinic operations. Senior management of both internal and external health agencies that are members of quality NCD clinic network would have to ensure that their clinical operations are closely linked with those of the quality NCD clinic program. It was recommended that networks of quality NCD clinic be established at all levels, as well as encouraging sharing and exchange of knowledge and experience to ensure close collaboration to adequately address the threat from NCDs. In addition, a working group or task force with clearly-defined mandate and roles and responsibilities will need to be appointed to ensure a concerted efforts to address NCD problems at the provincial, regional, and national levels.