Benchmarking Interventions Aimed at Improving Neurosurgical Patient Outcomes in Uganda (2019-2020)

Background

Since 2007, Duke’s Division of Global Neurosurgery and Neurology (DGNN) has been utilizing a health systems strengthening approach to improve neurological and neurosurgical care for patients throughout Uganda. This approach consists of provision of neurosurgical services, training of medical staff, research, twinning and advocacy. The long-term vision includes having 20 Uganda-trained neurosurgeons equitably spread across the country, increasing the number of facilities capable of providing neurosurgical operations, improving the infrastructure for neurosurgical care delivery and developing a Uganda Neuroscience Institute to serve as a center of neurosurgical and neurological excellence in East Africa.

Since 2016-2017, a Bass Connections project team has been working within DGNN’s framework to analyze challenges in neurosurgical care. In collaboration with partners in Uganda, the team has developed, tested and adapted multiple interventions to improve patient outcomes in the neurosurgery ward at Mulago National Referral Hospital in Kampala. Now, the team needs to set benchmarks to assess the performance of its interventions.

Project Description

In 2019-2020, this Bass Connections project team will begin benchmarking, a process through which internal controls are developed to evaluate whether an intervention is truly working. Once benchmarks are set, team members will conduct a study to test whether the use of benchmarking will increase the impact of interventions aimed at improving neurosurgical patient outcomes.

Team members will be divided into three subgroups and apply this research question to one of three strategic areas:

  • Infection Control: How far are we from reaching our benchmark of 85% staff hand sanitization compliance? What can we do to improve the impact of our intervention to reach this benchmark?
  • Medication Management: How far are we from reaching our benchmark of >90% correct medication prescription and >80% patient medication compliance? What can we do to improve the impact of our intervention to reach this benchmark?
  • Patient Family Education: How far are we from reaching our benchmark of >90% correct feeding technique (normal feeding, nasogastric tube feeding, gastrostomy tube feeding) on the ward? What can we do to improve the impact of our intervention to reach this benchmark?

Anticipated Outputs

Benchmarking processes for patient outcome interventions; shareable data that will offer insight into improving interventions; abstract for submission to Duke-specific and external conferences; manuscript for publication; grant development

Student Opportunities

Ideally, this team will include 15-18 students, including 6-9 undergraduates from diverse educational programs, 3-5 master’s students studying biomedical engineering or global health, 3-4 medical students and 1-2 postdocs.

We are specifically seeking team members interested in program evaluation and program improvement. Students with a desire to work in a low-resource setting and with a passion for surgical care are especially encouraged to apply.

Students on the team will have the opportunity to work on health systems strengthening within a low- to middle-income country setting and will be engaged in all stages of the research project, including fieldwork, data analysis, development of manuscripts and dissemination of research findings. Additionally, student team members will have the opportunity to work within the larger DGNN research group and gain insights and exposure from attending DGNN meetings.

Most of the students on the team will have the opportunity to travel to Kampala, Uganda, to participate in data collection activities during Summer 2019.

Timing

Summer 2019 – Spring 2020

  • Summer 2019: Begin weekly project team meetings; attend topic team meetings and DGNN meetings as scheduled; review previous team’s work and develop benchmarks for each intervention; participate in lecture series; engage in project implementation in Kampala, Uganda, from mid-July to mid-August
  • Fall 2019: Begin evaluation of project and research data
  • Spring 2020: Continue meetings; prepare and submit research abstracts, posters and manuscripts

Crediting

Independent study credit available for fall and spring semesters; summer funding available

See earlier related team, Evaluating Interventions Aimed at Improving Neurosurgical Patient Outcomes in Uganda (2018-2019).

 

Image: Mulago National Referral Hospital, courtesy of Chinemerem Nwosu

Mulago National Referral Hospital.

/faculty/staff Team Members

  • Anthony Fuller, School of Medicine-Surgery: Neurosurgery*
  • Michael Haglund, Duke Global Health Institute|School of Medicine-Surgery: Neurosurgery*
  • Shem Opolot, School of Medicine-Surgery: Neurosurgery
  • Joao Vissoci, School of Medicine-Surgery: Emergency Medicine

/zcommunity Team Members

  • Makerere University
  • Alex Mugalu, Department of Neurosurgery, Mulago Hospital (Uganda)
  • Christine Muhumuza, Department of Public Health, Makerere University (Uganda)
  • Michael Muhumuza, Department of Neurosurgery, Mulago Hospital (Uganda)
  • Juliet Ssekabunga, Department of Neurosurgery, Mulago Hospital (Uganda)