Establishing a learning health system in low and middle income countries

Research output: PhD ThesisPhd-Thesis - Research and graduation internal

Abstract

Poor quality care is a leading cause of excess mortality globally. In response, quality improvement (QI) interventions which have improved patients outcomes in high income countries have been championed in resource constrained healthcare settings. However, such methods have had limited success. The absence of granular data and lack of opportunities for frontline clinicians to gain the skills necessary to prioritise, implement and evaluate QI interventions, have stalled efforts to improve acute care. Learning health systems (LHS) embed knowledge generating processes to improve care in daily practice. With the aim of leveraging advancements in science, technology and practice to improve health-system performance, this thesis evaluates whether a LHS could be established in LMICs. We explored barriers to improving quality of acute care in LMICs, and then report on the design, implementation and scale up of the components of a LHS in 3 countries; a near-real time cloud based surveillance platform, and a community of practice, empowered to develop translational research, and implementation science skills to drive context-specific improvement. Subsequently we report a clinician-led evaluation of acute myocardial infarction care from admission to one year following discharge and the delivery of a peer delivered national training programme for newly qualified doctors in preparation for clinical practice. We conclude that establishing a LHS for acute care has successfully enabled a community of practice to evaluate and benchmark existing quality of care, understand contextual and organisational barriers to improving care, and deliver training to equip peers with the skills to care for acutely unwell patients.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • University of Amsterdam
Supervisors/Advisors
  • Schultsz, Constance, Supervisor
  • Dondorp, Arjen, Supervisor
  • Pell, Christopher, Co-supervisor
  • Haniffa, R., Co-supervisor, External person
Award date30 Sept 2020
Publication statusPublished - 2020

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