Abstract
BACKGROUND:
In healthcare, quality matters as much as coverage of services. Tuberculosis (TB) remains the leading infectious-disease killer, and even when full coverage exists, mortality, missed cases and patient loss to follow-up persist. To date, no studies elucidate whether objective measures of quality correlate with whether TB patients鈥� felt they received appropriate care.
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METHODS:
Using a dataset comprising 2,602 simulated patient-provider interactions across 1,203 facilities in Mumbai and Patna, we propose to assess differences between user experiences, subjective impressions of provider-patient interactions, and the quality of TB-specific care delivered by private providers.
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RESULTS:
To study the quality of urban-area TB care, from 2014-2017, 24 trained standardized patients (SPs) enacted four 鈥渃linical cases鈥� depicting different stages of TB-specific progression to representatively sampled providers. SPs were subsequently asked to rank their providers from 1鈥�10 (highest rating for satisfaction/performance). Using their ratings as the outcome, we present preliminary multiple linear regression analyses on 1448 informal and 1154 formal SP-provider interactions. Among informal providers, the estimated adjusted user ranking was 6.94 [95% CI 6.56-7.31] for clinically-correct managed cases using Indian TB care guidelines, 5.17 [95% CI 4.36-5.97] for male and 5.45 [95% CI 4.96-5.94] for female providers, and 3.31 [95% CI 2.78-3.83] when providers appeared very knowledgeable. For formal providers, the estimated adjusted rankings were 7.34 [95% CI 6.97-7.72], 6.84 [95% CI 5.64-8.04], 6.90 [95% CI 6.12-7.69], and 3.26 [95% CI 2.38-4.14], respectively.
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CONCLUSION:
Additional interaction characteristics, clinical measures, and objective quality measures associated with higher versus lower user rankings will be explored.
