1. Strengthening data collection and use for quality improvement in primary care: the case of Costa Rica
- Author
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José María Molina Granados, Oscar Villegas del Carpio, Ira B. Wilson, Asaf Bitton, Lauren Spigel, Hannah L. Ratcliffe, María del Rocío Saénz, Dan Schwarz, Madeline Pesec, Michael Pignone, Eduardo Zamora Méndez, Lisa R. Hirschhorn, and Jorge Arturo Jiménez Brizuela
- Subjects
Costa Rica ,Knowledge management ,Quality management ,media_common.quotation_subject ,education ,Qualitative property ,Population health ,Health informatics ,clinical ,03 medical and health sciences ,primary healthcare ,0302 clinical medicine ,Humans ,Quality (business) ,AcademicSubjects/MED00860 ,030212 general & internal medicine ,media_common ,Data collection ,Primary Health Care ,business.industry ,030503 health policy & services ,Health Policy ,Data Collection ,Public sector ,Central America ,Primary care ,health information system ,Quality Improvement ,Data system ,Original Article ,0305 other medical science ,business ,Delivery of Health Care - Abstract
Costa Rica is a bright spot of primary healthcare (PHC) performance, providing first-contact accessibility and continuous, comprehensive, coordinated, and patient-centered care to its citizens. Previous research hypothesized that strong data collection and use for quality improvement are central to Costa Rica’s success. Using qualitative data from 40 interviews with stakeholders across the Costa Rican healthcare system, this paper maps the various data streams at the PHC level and delineates how these data are used to make decisions around insuring and improving the quality of PHC delivery. We describe four main types of PHC data: individual patient data, population health data, national healthcare delivery data, and local supplementary healthcare delivery data. In particular, we find that the Healthcare Delivery Performance Index—a ranking of the nation’s 106 Health Areas using 15 quality indicators—is utilized by Health Area Directors to create quality improvement initiatives, ranging from education and coaching to optimization of care delivery and coordination. By ranking Health Areas, the Index harnesses providers’ intrinsic motivation to stimulate improvement without financial incentives. We detail how a strong culture of valuing data as a tool for improving population health and robust training for personnel have enabled effective data collection and use. However, we also find that the country’s complex data systems create unnecessary duplication and can inhibit efficient data use. Costa Rica’s experience with data collection, analysis, and use for quality improvement hold important lessons for PHC in other public sector systems.
- Published
- 2020