title: Integrated clinical and quality improvement coaching in Son La Province, Vietnam: a model of building public sector capacity for sustainable HIV care delivery.
abstract: BACKGROUND
  The global scale-up of antiretroviral therapy included extensive training and onsite support to build the capacity of HIV health care workers. However, traditional efforts aimed at strengthening knowledge and skills often are not successful at improving gaps in the key health systems required for sustaining high quality care.
  
  
  METHODS
  We trained and mentored existing staff of the Son La provincial health department and provincial HIV clinic to work as a provincial coaching team (PCT) to provide integrated coaching in clinical HIV skills and quality improvement (QI) to the HIV clinics in the province. Nine core indicators were measured through chart extraction by clinic and provincial staff at baseline and at 6 month intervals thereafter. Coaching from the team to each of the clinics, in both QI and clinical skills, was guided by results of performance measurements, gap analyses, and resulting QI plans.
  
  
  RESULTS
  After 18 months, the PCT had successfully spread QI activities, and was independently providing regular coaching to the provincial general hospital clinic and six of the eight district clinics in the province. The frequency and type of coaching was determined by performance measurement results. Clinics completed a mean of five QI projects. Quality of HIV care was improved throughout all clinics with significant increases in seven of the indicators. Overall both the PCT activities and clinic performance were sustained after integration of the model into the Vietnam National QI Program.
  
  
  CONCLUSIONS
  We successfully built capacity of a team of public sector health care workers to provide integrated coaching in both clinical skills and QI across a province. The PCT is a feasible and effective model to spread and sustain quality activities and improve HIV care services in a decentralized rural setting.
authors.affiliation: Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. lcosimi@partners.org.|The Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, 1309 Beacon St, Brookline, MA, USA. lcosimi@partners.org.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cosimi
authors.affiliation: Son La Department of Health, Son La Province, Vietnam. damvanhuong@gmail.com.
authors.forename: Huong V
authors.initials: HV
authors.lastname: Dam
authors.affiliation: The Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, 57 Ly Nam De St, Hanoi, Vietnam. thai2vn@gmail.com.
authors.forename: Thai Q
authors.initials: TQ
authors.lastname: Nguyen
authors.affiliation: Son La Department of Health, Son La Province, Vietnam. Hohuyensl@gmail.com.
authors.forename: Huyen T
authors.initials: HT
authors.lastname: Ho
authors.affiliation: The Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, 57 Ly Nam De St, Hanoi, Vietnam. Phuong@haivn.org.
authors.forename: Phuong T
authors.initials: PT
authors.lastname: Do
authors.affiliation: The Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, 57 Ly Nam De St, Hanoi, Vietnam. Duat@haivn.org.
authors.forename: Duat N
authors.initials: DN
authors.lastname: Duc
authors.affiliation: The Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, 57 Ly Nam De St, Hanoi, Vietnam. nguyenhuong021184@gmail.com.
authors.forename: Huong T
authors.initials: HT
authors.lastname: Nguyen
authors.affiliation: The Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, 1309 Beacon St, Brookline, MA, USA. bgardner@bidmc.harvard.edu.
authors.forename: Bridget
authors.initials: B
authors.lastname: Gardner
authors.affiliation: The Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, 1309 Beacon St, Brookline, MA, USA. hlibman@bidmc.harvard.edu.
authors.forename: Howard
authors.initials: H
authors.lastname: Libman
authors.affiliation: The Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, 57 Ly Nam De St, Hanoi, Vietnam. tpollack@haivn.org.
authors.forename: Todd
authors.initials: T
authors.lastname: Pollack
authors.affiliation: Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. lrh3@hms.harvard.edu.|Ariadne Labs, a joint Partnership with Brigham and Women's Hospital and Harvard School of Public Health, Landmark Center, Boston, MA, USA. lrh3@hms.harvard.edu.|Harvard Medical School, Boston, MA, USA. lrh3@hms.harvard.edu.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Hirschhorn
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D057191:Capacity Building / Q000458:organization & administration*; D002983:Clinical Competence; D003695:Delivery of Health Care; D015658:HIV Infections / Q000188:drug therapy*; D006282:Health Personnel; D006801:Humans; D008483:Medical Assistance; D009679:Nuclear Family; D017150:Public Sector; D058996:Quality Improvement / Q000458:organization & administration*; D014744:Vietnam
chemical_list: D044966:Anti-Retroviral Agents