Evaluating the impact of a hospital scale-up phase of a quality improvement intervention in Ghana on mortality for children under five

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objective</jats:title> <jats:p>To evaluate the scale-up phase of a national quality improvement initiative across hospitals in Southern Ghana.</jats:p> </jats:sec> <jats:sec> <jats:title>Design</jats:title> <jats:p>This evaluation used a comparison of pre- and post-intervention means to assess changes in outcomes over time. Multivariable interrupted time series analyses were performed to determine whether change categories (interventions) tested were associated with improvements in the outcomes.</jats:p> </jats:sec> <jats:sec> <jats:title>Setting</jats:title> <jats:p>Hospitals in Southern Ghana</jats:p> </jats:sec> <jats:sec> <jats:title>Participants</jats:title> <jats:p>The data sources were monthly outcome data from intervention hospitals along with program records.</jats:p> </jats:sec> <jats:sec> <jats:title>Intervention</jats:title> <jats:p>The project used a quality improvement approach whereby process failures were identified by health staff and process changes were implemented in hospitals and their corresponding communities. The three change categories were: timely care-seeking, prompt provision of care and adherence to protocols.</jats:p> </jats:sec> <jats:sec> <jats:title>Main outcome measures</jats:title> <jats:p>Facility-level neonatal mortality, facility-level postneonatal infant mortality and facility-level postneonatal under-five mortality.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>There were significant improvements for two outcomes from the pre-intervention to the post-intervention phase. Postneonatal infant mortality dropped from 44.3 to 21.1 postneonatal infant deaths per 1000 admissions, while postneonatal under-five mortality fell from 23.1 to 11.8 postneonatal under-five deaths per 1000 admissions. The multivariable interrupted time series analysis indicated that over the long-term the prompt provision of care change category was significantly associated with reduced postneonatal under five mortality (β = −0.0024, 95% CI −0.0051, 0.0003, P &lt; 0.10).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The reduced postneonatal under-five mortality achieved in this project gives support to the promotion of quality improvement as a means to achieve health impacts at scale.</jats:p> </jats:sec>