{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:02:37Z","timestamp":1753876957828,"version":"3.41.2"},"reference-count":30,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2019,7,19]],"date-time":"2019-07-19T00:00:00Z","timestamp":1563494400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate the scale-up phase of a national quality improvement initiative across hospitals in Southern Ghana.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>This evaluation used a comparison of pre- and post-intervention means to assess changes in outcomes over time. Multivariable interrupted time series analyses were performed to determine whether change categories (interventions) tested were associated with improvements in the outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Hospitals in Southern Ghana<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>The data sources were monthly outcome data from intervention hospitals along with program records.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention<\/jats:title>\n                  <jats:p>The project used a quality improvement approach whereby process failures were identified by health staff and process changes were implemented in hospitals and their corresponding communities. The three change categories were: timely care-seeking, prompt provision of care and adherence to protocols.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>Facility-level neonatal mortality, facility-level postneonatal infant mortality and facility-level postneonatal under-five mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were significant improvements for two outcomes from the pre-intervention to the post-intervention phase. Postneonatal infant mortality dropped from 44.3 to 21.1 postneonatal infant deaths per 1000 admissions, while postneonatal under-five mortality fell from 23.1 to 11.8 postneonatal under-five deaths per 1000 admissions. The multivariable interrupted time series analysis indicated that over the long-term the prompt provision of care change category was significantly associated with reduced postneonatal under five mortality (\u03b2 = \u22120.0024, 95% CI \u22120.0051, 0.0003, P &lt; 0.10).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The reduced postneonatal under-five mortality achieved in this project gives support to the promotion of quality improvement as a means to achieve health impacts at scale.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/intqhc\/mzz073","type":"journal-article","created":{"date-parts":[[2019,7,2]],"date-time":"2019-07-02T11:12:10Z","timestamp":1562065930000},"source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the impact of a hospital scale-up phase of a quality improvement intervention in Ghana on mortality for children under five"],"prefix":"10.1093","author":[{"given":"Kavita","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"},{"name":"Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilene","family":"Speizer","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"},{"name":"Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre M","family":"Barker","sequence":"additional","affiliation":[{"name":"The Institute for Healthcare Improvement (IHI), Cambridge, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josephine Nana Afrakoma","family":"Agyeman-Duah","sequence":"additional","affiliation":[{"name":"The National Catholic Health Secretariat (NCHS), Tamale, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justina","family":"Agula","sequence":"additional","affiliation":[{"name":"The National Catholic Health Secretariat (NCHS), Tamale, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas Kofi","family":"Akpakli","sequence":"additional","affiliation":[{"name":"The National Catholic Health Secretariat (NCHS), Tamale, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salomey","family":"Akparibo","sequence":"additional","affiliation":[{"name":"The National Catholic Health Secretariat (NCHS), Tamale, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ireneous N","family":"Dasoberi","sequence":"additional","affiliation":[{"name":"The National Catholic Health Secretariat (NCHS), Tamale, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernest","family":"Kanyoke","sequence":"additional","affiliation":[{"name":"The National Catholic Health Secretariat (NCHS), Tamale, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna Hermina","family":"Steenwijk","sequence":"additional","affiliation":[{"name":"The National Catholic Health Secretariat (NCHS), Tamale, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elma","family":"Yabang","sequence":"additional","affiliation":[{"name":"The National Catholic Health Secretariat (NCHS), Tamale, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nana A Y","family":"Twum-Danso","sequence":"additional","affiliation":[{"name":"MAZA, Accra, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sodzi","family":"Sodzi-Tettey","sequence":"additional","affiliation":[{"name":"The Institute for Healthcare Improvement (IHI), Cambridge, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,7,19]]},"reference":[{"volume-title":"Nobody\u2019s Business. Strengthening Health Systems to Improve Health Outcomes. WHO\u2019s Framework for Action","year":"2007","author":"WHO","key":"2019071910195816600_mzz073C1"},{"key":"2019071910195816600_mzz073C2","doi-asserted-by":"crossref","first-page":"PE1196","DOI":"10.1016\/S2214-109X(18)30386-3","article-title":"High-quality health systems in the sustainable development goals era: time for a revolution","volume":"6","author":"Kruk","year":"2018","journal-title":"Lancet Glob Health"},{"volume-title":"Engineering, and Medicine. Crossing the Global Quality Chasm: Improving Health Care Worldwide","year":"2018","author":"National Academies of Sciences","key":"2019071910195816600_mzz073C3"},{"volume-title":"Delivering Quality Health Services: A Global Imperative","year":"2018","author":"OECD\/WHO\/World Bank Group","key":"2019071910195816600_mzz073C4"},{"key":"2019071910195816600_mzz073C5","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/intqhc\/mzt039","article-title":"A quality improvement model for the rapid scale-up of a program to prevent mother-to-child HIV transmission in South Africa","volume":"25","author":"Mate","year":"2013","journal-title":"Int J Qual Health Care"},{"key":"2019071910195816600_mzz073C6","doi-asserted-by":"crossref","first-page":"e981","DOI":"10.1136\/bmj.e981","article-title":"Improving the delivery of safe and effective healthcare in low and middle income countries","volume":"344","author":"Massoud","year":"2012","journal-title":"BMJ"},{"key":"2019071910195816600_mzz073C7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/intqhc\/mzy020","article-title":"Salzburg Global Seminar Session 565-\u2018Better Health Care: how do we learn about improvement?\u2019","volume":"30","author":"Massoud","year":"2018","journal-title":"Int J Qual Health Care"},{"year":"2016","author":"Chowfla","key":"2019071910195816600_mzz073C8"},{"year":"2017","author":"AcademyHealth","key":"2019071910195816600_mzz073C9"},{"key":"2019071910195816600_mzz073C10","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1093\/intqhc\/mzy013","article-title":"Adapting improvements to context: when, why and how?","volume":"30","author":"Ovretveit","year":"2018","journal-title":"Int J Qual Health Care"},{"year":"2007","author":"Ghana\u2019s Ministry of Health","key":"2019071910195816600_mzz073C11"},{"key":"2019071910195816600_mzz073C12","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1093\/intqhc\/mzt054","article-title":"Impact evaluation of a quality improvement intervention on maternal and child health outcomes in Northern Ghana: Early assessment of a national scale-up project","volume":"25","author":"Singh","year":"2013","journal-title":"Int J for Qual Health Care"},{"key":"2019071910195816600_mzz073C13","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1093\/intqhc\/mzs060","article-title":"A nationwide quality improvement project to accelerate Ghana\u2019s progress toward Millennium Development Goal Four: design and implementation progress","volume":"24","author":"Twum-Danso","year":"2012","journal-title":"Int J for Qual Health Care"},{"key":"2019071910195816600_mzz073C14","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s12961-016-0115-2","article-title":"Can a quality improvement project impact maternal and child health outcomes at scale in northern Ghana?","volume":"14","author":"Singh","year":"2016","journal-title":"Health Policy Res Syst"},{"volume-title":"Lessons Learned from Ghana\u2019s Project Fives Alive! A Practical Guide for Designing and Executing Large-Scale Improvement Initiative","year":"2015","author":"Sodzi-Tettey","key":"2019071910195816600_mzz073C15"},{"key":"2019071910195816600_mzz073C16","volume-title":"The Improvement Guide: A Practical Approach to Enhancing Organizational Performance","author":"Langley","year":"2009","edition":"2nd edn"},{"volume-title":"The Breakthrough Series: IHI\u2019s Collaborative Model for Achieving Breakthrough Performance","year":"2003","author":"Institute for Healthcare Improvement","key":"2019071910195816600_mzz073C17"},{"key":"2019071910195816600_mzz073C18","doi-asserted-by":"crossref","DOI":"10.1186\/s13012-018-0712-2","article-title":"Quality improvement initiatives for hospitalised small and sick newborns in low- and middle-income countries: a systematic review","volume":"13","author":"Zaka","year":"2018","journal-title":"Implement Sci"},{"key":"2019071910195816600_mzz073C19","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1186\/1742-4755-11-S2-S1","article-title":"Approaches to improve the quality of maternal and newborn health care: an overview of the evidence","volume":"11","author":"Austen","year":"2014","journal-title":"Reprod Health"},{"volume-title":"Experimental and Quasi-Experimental Designs for Research","year":"1963","author":"Campbell","key":"2019071910195816600_mzz073C20"},{"key":"2019071910195816600_mzz073C21","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1023\/A:1010024016308","article-title":"The value of interrupted time series experiments for community intervention research","volume":"1","author":"Biglan","year":"2000","journal-title":"Prev Sci"},{"key":"2019071910195816600_mzz073C22","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1093\/aje\/kwf215","article-title":"Statistical analysis of correlated data using generalized estimating equations: an orientation","volume":"157","author":"Hanley","year":"2003","journal-title":"Am J Epidemiol"},{"key":"2019071910195816600_mzz073C23","doi-asserted-by":"crossref","first-page":"269","DOI":"10.3758\/BF03207794","article-title":"Regression analysis of correlated binary outcomes","volume":"32","author":"Sheu","year":"2000","journal-title":"Behav Res Methods Instrum Comput"},{"key":"2019071910195816600_mzz073C24","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1177\/1094428104263672","article-title":"Using generalized estimating equations for longitudinal data analysis","volume":"7","author":"Ballinger","year":"2004","journal-title":"Organ Res Meth"},{"key":"2019071910195816600_mzz073C25","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1023\/A:1010024016308","article-title":"The value of interrupted time series experiments for community intervention research","volume":"1","author":"Biglan","year":"2000","journal-title":"Prev Sci"},{"key":"2019071910195816600_mzz073C26","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12916-018-1024-8","article-title":"Hospital mortality\u2014a neglected but rich source of information supporting the transition to higher quality health systems in low and middle income countries","volume":"16","author":"English","year":"2018","journal-title":"BMC Med"},{"year":"2018","author":"UNICEF","key":"2019071910195816600_mzz073C27"},{"key":"2019071910195816600_mzz073C28","doi-asserted-by":"crossref","first-page":"176","DOI":"10.2471\/BLT.11.092759","article-title":"Improving public health information: a data quality intervention in KwaZulu-Natal, South Africa","volume":"90","author":"Mphatswe","year":"2011","journal-title":"Bull World Health Organ"},{"key":"2019071910195816600_mzz073C29","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s13012-016-0374-x","article-title":"A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa","volume":"11","author":"Barker","year":"2016","journal-title":"Implement Sci"},{"year":"2018","author":"Parry","key":"2019071910195816600_mzz073C30"}],"container-title":["International Journal for Quality in Health Care"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/intqhc\/advance-article-pdf\/doi\/10.1093\/intqhc\/mzz073\/28962914\/mzz073.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"}],"deposited":{"date-parts":[[2019,9,20]],"date-time":"2019-09-20T10:40:14Z","timestamp":1568976014000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/intqhc\/advance-article\/doi\/10.1093\/intqhc\/mzz073\/5536102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,19]]},"references-count":30,"URL":"https:\/\/doi.org\/10.1093\/intqhc\/mzz073","relation":{},"ISSN":["1353-4505","1464-3677"],"issn-type":[{"type":"print","value":"1353-4505"},{"type":"electronic","value":"1464-3677"}],"subject":[],"published":{"date-parts":[[2019,7,19]]},"article-number":"mzz073"}}