To ensure data quality, we (i) field-tested the template used for collecting data on indicators of inappropriate case management, which included an explicit definition of each indicator, before being used in the study; (ii) field-tested data collectors’ performance before the study and their understanding was reinforced, if necessary, to ensure consistency; (iii) rotated data collectors among hospitals to reduce the influence of subjectivity; (iv) determined the reliability of the data collectors in evaluating medical records by comparing their evaluations with those of a team of independent international paediatricians at time points T1, T2 and T6 (Fig.2); and (v) monitored the completeness and internal consistency of the data collected by an external independent data analyst at regular intervals after each supportive supervision visit.The study investigators checked the spreadsheets for internal consistency after each data collection. time point T1), health staff, data collectors, patients and data analysts were all blinded to the study allocation group. T2 to T6), neither hospital staff nor the supportive supervision team could be blinded but they were not involved in data collection or data analysis.Data collectors knew the allocation group but were not involved in data analysis.The main sections are: (i) hospital support systems; (ii) case management; and (iii) policies and organization of care.Using structured checklists in the assessment tool, the team attributed a score to each of approximately 250 items based on standards derived from WHO recommendations and other relevant guidelines.During each hospital visit, two paediatricians provided supportive supervision over 1 or 2 days based on a peer-to peer, plan–do–study–act model, which involved: (i) identifying and agreeing on the actions needed to improve the quality of care; (ii) implementing those actions; (iii) monitoring progress; and (iv) discussing any additional actions needed.
The tool systematically assesses different components of the health system that contribute to quality of care – it includes three main sections and a total of 17 subsections.
World Health Organization Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Via dell’Istria 65/1, Trieste, 34137, Italy.b.
State Medical Institute of Postgraduate and Continuous Training, Bishkek, Kyrgyzstan.c.
Data collectors filled in a paper-based template for the indicators.
Subsequently, two data collector coordinators transferred this information into a predefined electronic spreadsheet, which they then sent to the study investigators by email.