Quality Improvement
QUOTE-TB
What is QUOTE-TB
QUOTE-TB is an instrument to measure the quality of services as perceived by tuberculosis (TB) patients. QUOTE is an acronym for Quality of Care as seen through the Eyes of the Patient. QUOTE-TB consists of two questionnaires: one to measure the performance of TB services (routinely) and one to measure importance (once every five years). The combination of the two scores measures the quality of TB services, expressed as quality impact (QI) index. The essence is that the importance scores are used as weighing factors for performance scores.
The tool is unique because TB patients are involved in all stages of its development, and the information obtained by using the tool adds the patient’s perspective to measuring quality in TB control. Involving patients in the improvement process will contribute to the empowerment of TB patients and their communities.
QUOTE-TB is also contextually specific. It has been developed for an East African context and will need to be adapted for other contexts. East African patients may find certain aspects of TB services more important than, for example, patients in Europe or South-East Asia. Moreover, importance – even in the same context – may change over time.
The most important dimensions of quality of care for TB patients are:
- Availability and accessibility of TB services;
- Information to TB patients;
- Provider interaction and counselling;
- Infrastructure;
- Procedures and tests;
- Costs and payments;
- TB/HIV relationship; and
- Support.
Using QUOTE-TB on three levels
QUOTE-TB can be used as an instrument for quality improvement at national, district and facility level. Interviews of TB patients take place at facility level. These can be public or private facilities. Also, defaulters could be traced and interviewed, as they have their own expectations and experiences of the health services. An example of how to calculate performance and quality impact scores is provided.
At national level the tool provides a standardized method to measure quality of care from the TB patient perspective in external reviews of the National TB Programme (NTP). Also, it can be used for internal ongoing monitoring of NTP performance and for benchmarking: it provides a nationwide view on quality of care for the NTP and discloses quality differences between districts and between facilities within districts.
At district level the tool allows analysis of all reviewed health facilities and benchmarking at the district level by providing an overall view of quality of care by district and of differences between health facilities.
At health facility level QUOTE-TB and its methodology can be used in facilities with more than 50 TB patients. In facilities with fewer than 50 TB patients the performance part of the tool can be used as a patient exit interview to reveal performance gaps. The picture cards can be useful in focus group discussions to discuss and improve services at facility level.
Adaptation of QUOTE-TB to use in countries with different TB epidemiology and/or different cultural and other socio-economic settings is described.