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Quality Improvement Program Expands to National Level in Russia
by Cynthia Young, Senior Writer

The Quality Assurance Project (QAP) recently launched the third phase of its groundbreaking work in the Russian Federation to scale-up quality improvement of healthcare to a national level.



The Collaborative Directors and Project Director, Rashad Massoud, toast to a new beginning. Photo by Kim Ethier.

The Russian Ministry of Health launched this expansion at a Moscow conference December 17 - 18, 2002. The event inaugurated Phase III of the joint project to adapt the quality management (QI) methodology to the Russian healthcare system. Partnering organizations include the U.S. Agency for International Development (USAID) and the Agency for Healthcare Research and Quality (AHRQ).

Health administration leaders and specialists from 31 Departments of Health (including cities, regions, oblasts, republics, and autonomous republics) learned about the extraordinary clinical results of Phases I and II of the Russia QA Project. Participants reviewed data from the successful demonstration projects and discussed organizing programs, choosing facilities, and creating teams to implement the national scale-up.

QAP has been working with the Central Public Health Research Institute, part of the Russian Ministry of Health, since 1998. During Phase I (1998-2000), health department leaders chose Tula and Tver Oblasts (an oblast is an administrative region) for demonstration projects in their top priority areas: to improve quality of treatment of women with pregnancy-induced hypertension (PIH), reduce respiratory distress syndrome (RDS) in newborns, and improve care for patients with arterial hypertension (AH).

These pilot projects yielded impressive results.



A map of Russia marked with all the participating Subjects of the Russian Federation in the national scale-up of quality improvement. Photo by Kim Ethier

In Tula Oblast key results of improving the system of hypertension care in pilot facilities (in 5 clinics, 1998-2000) included: a seven-fold increase in the number of patients managed at the primary care level, blood pressure stabilization in 69 percent of patients, a 60 percent decrease in hypertensive crises, and an 85 percent decrease in hypertension-related hospitalizations. Economic analysis showed an overall reduction of 23 percent in the cost of hospital care for patients with hypertension.

In Tver Oblast, to improve care for newborns with RDS, the system of neonatal care was redesigned in 5 hospitals (1999-2000). A central referral neonatal intensive care unit was created, a neonatal ambulance system was set up, and neonatal resuscitation training was conducted. Results included a 7-day survival rate of 95 percent after initial resuscitation and a 64 percent reduction in neonatal mortality due to RDS.

In Tver, significant effects of improving treatment for women with PIH in 3 hospitals (1998-2000) included a 77 percent reduction in hospitalizations due to PIH and no cases of maternal deaths or progression to eclampsia. The new system of PIH care showed an overall 87 percent reduction in costs compared to the old system.

These demonstration projects were expanded oblast-wide during Phase II (2000-2002). In Tver Oblast, the PIH and RDS programs were expanded to 42 healthcare facilities. In Tula Oblast, the AH program was expanded to close to 500 primary care physicians’ practices.

Improvements in the systems of RDS and PIH care in Phase II are already visible. Results of improving RDS care through Tver Oblast include:

A 87 percent seven-day survival rate after initial resuscitation
A 62 percent reduction in neonatal mortality due to RDS
A 99 percent reduction in hypothermia in neonates transported to the neonatal intensive care center
Reduction in level of early neonatal mortality by half (49.6 percent, from 10.8 per 1,000 in 1998 to 5.3 per 1,000 in 2001)

Outcomes of improving the system of PIH care in Tver Oblast in Phase II include:

A decrease in the percentage of women who delivered with PIH
A decrease in the percentage of women with progression to eclampsia
Only one death due to PIH

Early effects of improving the system of hypertensive care in Tula Oblast in Phase II include reduction in hospitalizations due to AH, reduction in incidence of hypertensive crises, and a reduction in strokes and myocardial infarctions.

Phase III, the national scale-up that began in 2002, will spread the QI methodology on the national level. It will build on the achievements of Phase II and address additional clinical areas such as depression, prevention of non-communicable chronic diseases, tuberculosis, and neonatal care.

For more information on QAP's work in Russia, contact Kim Ethier at kethier@urc-chs.com.

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