1. 2. Centre for Primary Care, University of Manchester
Patient centricity and primary health care quality improvement in Nigeria: opportunities with the Patient Evaluation Scale (PES)
Dr Daprim S. Ogaji1,2
1. Department of Preventive and Social Medicine, University of Port Harcourt
2. Centre for Primary Care, University of Manchester

2. What is known
Patient evaluation is an evidence based approach to quality assessment and improvement in health care
Underpinned by –
Ethics – Autonomy
Reforms – patient centricity
Philosophy – Consumerism, accountability
Law and regulation – legitimacy, patient centricity
Politic - Responsiveness
Practical benefits - health care utilization, compliance with treatment, continuity of care, effectiveness of care
Context
Objective
To explore opportunities for improving PHC with the PES
PES
PES - 27-item scale with 5-point response format (poor to excellent) and 8 dimensions.
developed through multiphase mixed method research.
Developed for exit assessment of patient experiences with PHC in Nigeria

3. What was done Literature review Re-analyses of quantitative data
Data from 1649 patients in 24 PHC Centres, 12 LGA, 6 States representing 6 GPZs
PES QUALISTRAT is a series of analyses and presentation of ratings and categorical responses
Colour codes of performance
Red light = serious deficiencies
Yellow = suboptimal,
Green = optimal performance
Threshold of 50 and 75th percentile of a national reference
Isolated performance assessment
Gauze performance with reference
Current performance
Trailing performance

4. PES QUALISTRAT Comparing with population reference Current performance
PHC aspects positively evaluated - % response (good, very good and excellent)
Unit assessment on each indicator
Descriptive statistics (mean, standard deviation, median, and quartile deviation)
A distribution frequency table
An aggregated chart with the average value (mean ± SD or Median ± upper and lower quartile)
An aggregated chart with the average value (mean ± SD or Median ± upper and lower quartile) for each of the eight dimensions of PES
Comparing with population reference
Current performance
% excellent response relative to reference
percentile ranking relative to the reference
comparing the performance in relation to the 25th, 50th and 75th percentile of the reference
Trail
graph depicting change in patient evaluation over time with or without comparison with the reference.

5. Results

6. Performance of a health centre with the 25th and 75th percentile reference thresholds

7. Opportunities
The PES can be utilized for cross-sectional and longitudinal surveys on patients’ experiences with PHC.
Findings can be interpreted qualitatively or quantitatively
Individual items which describes aspects of PHC or a summation of these items in domains or entire scale.
The PES can be used for periodic nation-wide patient surveys, benchmarking, trend analysis, performance ranking and timely problem identification in Nigerian PHC system.
Adoption in the State Peer Review Mechanism
The contents of the PES questionnaire inform its suitability for measuring the structure, process and outcome of care
and
Some core defining characteristics of PHC such as: accessibility (geographic, financial, organisational); comprehensiveness, preventive focus and effectiveness of care

8. Patient evaluation and continuous quality improvement in PHC

9. Cross-cutting issues Implications Single vs. Summated analysis
Parametric vs. non parametric analysis
Hierarchical vs non-hierarchical analysis
Interviewer vs. self-administered questionnaire
Implications
Opportunities for large-scale patient-based review
Simple, clear and actionable presentation
Attraction for researchers, practitioners and policy makers.
Advocate periodic nation-wide patient surveys, benchmarking, trend analysis, performance ranking for timely problem identification in Nigerian PHC system.
Integrate approach in existing State Peer Review
Simple home-grown methodologies
Improve the social relevance of PHC in Nigeria.