Health impact assessment and short-term medical missions: a methods study to evaluate quality of care

Abstract

Background: Short-term medical missions (STMMs) are a well-established means of providing health care to the developing world. Despite over 250 million dollars and thousands of volunteer hours dedicated to STMMs, there is a lack of standardized evaluation to assess patient safety, quality control, and mission impact. The objective of this project is to design and implement an assessment tool that defines objective parameters of quality of care as identified by STMMs.

Methods: The study was conducted in 3 phases: 1) Base-need analysis to determine factors critical to the quality of STMMs, 2) Design of 5 surveys for mission personnel and patients to enable 360-degree evaluation based on factors from phase 1, and 3) Field testing of the surveys with 5 STMMs.

Results: An evaluation tool was created assessing 6 major and 30 minor factors identified as important to the quality of STMMs. 5 mission directors, 43 personnel, 10 local hosts, and 55 patients completed the surveys. Of the 6 major measures of quality, missions performed best in Cost (mean score 86%), and Impact (84%). The poorest performance was in Education (64%). Efficiency, Sustainability, and Preparedness showed mean scores of 76%, 77%, and 73%, respectively.

Conclusion: Our study provides a novel standardized tool for STMM evaluation. Use of the assessment instrument identified areas of strength and weakness of a particular mission, and delineated general trends in performance compared to other STMMs. We anticipate that the use of this tool may improve the quality of care provided by missions, and stimulate solution-sharing and scholarly discussion among missions.

Figures

Figure 1

Example Summary Report of 6 Major factors. For a given mission, percentages are given representing scores for the 6 major factors. This allows the mission to view their scores for the 6 factors and compare the percentages within that mission to target quality improvement. In this example, the mission scored the highest in Sustainability and the lowest in Education. Thus, for this mission they may consider targeting their education initiatives as a means for quality improvement.

Figure 2

Sample Survey Question on STMM Feedback Report. This question is graphically represented with the Universal Average (the mean responses from all missions that have completed the surveys), compared alongside the specific answer from STMM A. In this sample question, the director of Mission A completely agreed that referral was easy compared to the universal average where 40% of missions completely agreed, 40% somewhat agreed and 20% were indifferent. The universal average of Likert response and standard deviation is also given in the graph as 1.8 and 0.7483 respectively.