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• W1844147158 abstract "This article examines the reliability and validity of direct observation of patient-provider encounters, interviews with providers, and use of patients simulating sexually transmitted diseases (STD) as methods for assessing the quality of STD case management in developing countries. Data were collected during an STD health facility survey in Malawi; the performance of 49 providers was observed, and the providers were also interviewed; 20 of them were visited by a simulated patient complaining of urethral discharge. Agreement (based on the kappa statistic) was generally poor between direct observation and provider-interview data, and also between direct observation and simulated-patient data. In contrast, percentage agreements between direct observation and simulated-patient data were often high. Multiple observations on providers indicated that a provider's behaviour is not consistent across several patients. Simulated-patient data are probably the best in reflecting normal performance, but their feasibility for routine quality assessment is limited because the provider's behaviour is not consistent and would require multiple data points. Direct observation data are the best option for assessing quality if the results are assumed to reflect better than normal levels of quality of care. Data from interviews with providers should be viewed with caution, because they may reflect provider knowledge and not necessarily performance.The quality of health care delivery in developing countries has been assessed by many studies using the following methods: direct observation of patient-provider encounters, review of records, exit interviews with clients, interviews with providers, and inventories of facilities, drugs, and supplies. This paper assesses the reliability and validity of the following methods used in a nationwide survey of STD case management conducted in health facilities in Malawi in 1994: the direct observation of provider-patient encounters, interviews with providers, and the use of people who pretend to be patients. The performance of 49 providers was observed. All of the providers were also interviewed and 20 were visited by a simulated patient complaining of urethral discharge. Multiple observations of providers indicated that any given provider does not behave in the same manner with all patients. Simulated-patient data can probably give the most accurate view of a provider's typical performance, but the approach has only limited use in routine quality assessment because the inconsistent nature of providers' behavior would require multiple data points per provider. Direct observation data are the best when measuring quality if the results are thought to be of higher quality than normal care. Data from interviews with providers should be carefully interpreted since they may reflect only provider knowledge and not his or her actual performance." @default.
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• W1844147158 title "Quality of case management of sexually transmitted diseases: comparison of the methods for assessing the performance of providers." @default.
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