title: Immediate outcome indicators in perioperative care: a controlled intervention study on quality improvement in hospitals in Tanzania.
abstract: BACKGROUND
  Outcome assessment is the standard for evaluating the quality of health services worldwide. In this study, outcome has been divided into immediate and final outcome. Aim was to compare an intervention hospital with a Continuous Quality Improvement approach to a control group using benchmark assessments of immediate outcome indicators in surgical care. Results were compared to final outcome indicators.
  
  
  METHODS
  Surgical care quality in six hospitals in Tanzania was assessed from 2006-2011, using the Hospital Performance Assessment Tool. Independent observers assessed structural, process and outcome quality using checklists based on evidence-based guidelines. The number of surgical key procedures over the benchmark of 80% was compared between the intervention hospital and the control group. Results were compared to Case Fatality Rates.
  
  
  RESULTS
  In the intervention hospital, in 2006, two of nine key procedures reached the benchmark, one in 2009, and four in 2011. In the control group, one of nine key procedures reached the benchmark in 2006, one in 2009, and none in 2011. Case Fatality Rate for all in-patients in the intervention hospital was 5.5% (n = 12,530) in 2006, 3.5% (n = 21,114) in 2009 and 4.6% (n = 18,840) in 2011. In the control group it was 3.1% (n = 17,827) in 2006, 4.2% (n = 13,632) in 2009 and 3.8% (n = 17,059) in 2011.
  
  
  CONCLUSIONS
  Results demonstrated that quality assurance improved performance levels in both groups. After the introduction of Continuous Quality Improvement, performance levels improved further in the intervention hospital while quality in the district hospital did not. Immediate outcome indicators appeared to be a better steering tool for quality improvement compared to final outcome indicators. Immediate outcome indicators revealed a need for improvement in pre- and postoperative care.
  
  
  CONCLUSIONS
  Quality assurance programs based on immediate outcome indicators can be effective if embedded in Continuous Quality Improvement. Nevertheless, final outcome indicators cannot be neglected.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte, Charité-University Medicine Berlin, Berlin, Germany. goetz.bosse@charite.de
authors.forename: Goetz
authors.initials: G
authors.lastname: Bosse
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mtatifikolo
authors.forename: Wiltrud
authors.initials: W
authors.lastname: Abels
authors.forename: Christian
authors.initials: C
authors.lastname: Strosing
authors.forename: Jan-Philipp
authors.initials: JP
authors.lastname: Breuer
authors.forename: Claudia
authors.initials: C
authors.lastname: Spies
mesh_terms: D057189:Checklist; D006761:Hospitals / Q000592:standards*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000592:standards*; D019990:Perioperative Care / Q000592:standards / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000592:standards / Q000706:statistics & numerical data*; D013636:Tanzania