Process evaluation of implementation fidelity of the integrated chronic disease management model in two districts, South Africa

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dc.contributor.authorLebina, Limakatso
dc.contributor.authorAlaba, Olufunke
dc.contributor.authorRingane, Ashley
dc.contributor.authorHlongwane, Khuthadzo
dc.contributor.authorPule, Pogiso
dc.contributor.authorOni, Tolu
dc.contributor.authorKawonga, Mary
dc.date.accessioned2020-01-14T06:51:00Z
dc.date.available2020-01-14T06:51:00Z
dc.date.issued2019-12-16
dc.date.updated2019-12-22T05:18:24Z
dc.description.abstractAbstract Background The Integrated Chronic Disease Management (ICDM) model has been implemented in South Africa to enhance quality of clinical services in Primary Healthcare (PHC) clinics in a context of a high prevalence of chronic conditions and multi-morbidity. This study aimed to assess the implementation fidelity (adherence to guidelines) of the ICDM model. Methods A cross-sectional study in 16 PHC clinics in two health districts in South Africa: Dr. Kenneth Kaunda (DKK) and West Rand (WR). A fidelity assessment tool with 89 activities and maximum score of 158 was developed from the four interrelated ICDM model components: facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems. Value stream mapping of patient flow was conducted to analyse waiting time and identify operational inefficiencies. ICDM items were scored based on structured observations, facility document reviews and structured questionnaires completed by healthcare workers. Fidelity scores were summarized using medians and proportions and compared by facilities and districts using Chi-Square and Kruskal Wallis test. Results The monthly patient headcount over a six-month period in these 16 PHC clinics was a median of 2430 (IQR: 1685–2942) individuals over 20 years. The DKK district had more newly diagnosed TB patients per month [median 5.5 (IQR: 4.00–9.33) vs 2.0 (IQR: 1.67–2.92)], and fewer medical officers per clinic [median 1 (IQR: 1–1) vs 3.5 (IQR:2–4.5)] compared to WR district. The median fidelity scores in both districts for facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems were 78% [29/37, IQR: 27–31)]; 77% [30/39 (IQR: 27–34)]; 77% [30/39 (IQR: 28–34)]; and 80% [35/44 (IQR: 30–37)], respectively. The overall median implementation fidelity of the ICDM model was 79% (125/158, IQR, 117–132); WR was 80% (126/158, IQR, 123–132) while DKK was 74% (117/158, IQR, 106–130), p = 0.1409. The lowest clinic fidelity score was 66% (104/158), while the highest was 86% (136/158). A patient flow analysis showed long (2–5 h) waiting times and one stream of care for acute and chronic services. Conclusion There was some variability of scores on components of the ICDM model by PHC clinics. More research is needed on contextual adaptations of the model.
dc.identifier.apacitationLebina, L., Alaba, O., Ringane, A., Hlongwane, K., Pule, P., Oni, T., & Kawonga, M. (2019). Process evaluation of implementation fidelity of the integrated chronic disease management model in two districts, South Africa. http://hdl.handle.net/11427/30721en_ZA
dc.identifier.chicagocitationLebina, Limakatso, Olufunke Alaba, Ashley Ringane, Khuthadzo Hlongwane, Pogiso Pule, Tolu Oni, and Mary Kawonga "Process evaluation of implementation fidelity of the integrated chronic disease management model in two districts, South Africa." (2019) http://hdl.handle.net/11427/30721en_ZA
dc.identifier.citationBMC Health Services Research. 2019 Dec 16;19(1):965
dc.identifier.ris TY - Journal Article AU - Lebina, Limakatso AU - Alaba, Olufunke AU - Ringane, Ashley AU - Hlongwane, Khuthadzo AU - Pule, Pogiso AU - Oni, Tolu AU - Kawonga, Mary AB - Abstract Background The Integrated Chronic Disease Management (ICDM) model has been implemented in South Africa to enhance quality of clinical services in Primary Healthcare (PHC) clinics in a context of a high prevalence of chronic conditions and multi-morbidity. This study aimed to assess the implementation fidelity (adherence to guidelines) of the ICDM model. Methods A cross-sectional study in 16 PHC clinics in two health districts in South Africa: Dr. Kenneth Kaunda (DKK) and West Rand (WR). A fidelity assessment tool with 89 activities and maximum score of 158 was developed from the four interrelated ICDM model components: facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems. Value stream mapping of patient flow was conducted to analyse waiting time and identify operational inefficiencies. ICDM items were scored based on structured observations, facility document reviews and structured questionnaires completed by healthcare workers. Fidelity scores were summarized using medians and proportions and compared by facilities and districts using Chi-Square and Kruskal Wallis test. Results The monthly patient headcount over a six-month period in these 16 PHC clinics was a median of 2430 (IQR: 1685–2942) individuals over 20 years. The DKK district had more newly diagnosed TB patients per month [median 5.5 (IQR: 4.00–9.33) vs 2.0 (IQR: 1.67–2.92)], and fewer medical officers per clinic [median 1 (IQR: 1–1) vs 3.5 (IQR:2–4.5)] compared to WR district. The median fidelity scores in both districts for facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems were 78% [29/37, IQR: 27–31)]; 77% [30/39 (IQR: 27–34)]; 77% [30/39 (IQR: 28–34)]; and 80% [35/44 (IQR: 30–37)], respectively. The overall median implementation fidelity of the ICDM model was 79% (125/158, IQR, 117–132); WR was 80% (126/158, IQR, 123–132) while DKK was 74% (117/158, IQR, 106–130), p = 0.1409. The lowest clinic fidelity score was 66% (104/158), while the highest was 86% (136/158). A patient flow analysis showed long (2–5 h) waiting times and one stream of care for acute and chronic services. Conclusion There was some variability of scores on components of the ICDM model by PHC clinics. More research is needed on contextual adaptations of the model. DA - 2019-12-16 DB - OpenUCT DP - University of Cape Town KW - Intervention adherence KW - ICDM model KW - Chronic care model KW - Implementation research KW - Value stream mapping LK - https://open.uct.ac.za PY - 2019 T1 - Process evaluation of implementation fidelity of the integrated chronic disease management model in two districts, South Africa TI - Process evaluation of implementation fidelity of the integrated chronic disease management model in two districts, South Africa UR - http://hdl.handle.net/11427/30721 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12913-019-4785-7
dc.identifier.urihttp://hdl.handle.net/11427/30721
dc.identifier.vancouvercitationLebina L, Alaba O, Ringane A, Hlongwane K, Pule P, Oni T, et al. Process evaluation of implementation fidelity of the integrated chronic disease management model in two districts, South Africa. 2019; http://hdl.handle.net/11427/30721.en_ZA
dc.language.rfc3066en
dc.rights.holderThe Author(s).
dc.subjectIntervention adherence
dc.subjectICDM model
dc.subjectChronic care model
dc.subjectImplementation research
dc.subjectValue stream mapping
dc.titleProcess evaluation of implementation fidelity of the integrated chronic disease management model in two districts, South Africa
dc.typeJournal Article
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