Magnitude and pattern of improvement in processes of care for hospitalised children with diarrhoea and dehydration in Kenyan hospitals participating in a clinical network

Objective WHO recommends optimisation of available interventions to reduce deaths of under‐five children with diarrhoea and dehydration (DD). Clinical networks may help improve practice across many hospitals but experience with such networks is scarce. We describe magnitude and patterns of changes in processes of care for children with DD over the first 3 years of a clinical network. Methods Observational study involving children aged 2–59 months with DD admitted to 13 hospitals participating in the clinical network. Processes of individual patient care including agreement of assessment, diagnosis and treatment according to WHO guidelines were combined using the composite Paediatric Admission Quality of Care (PAQC) score (range 0–6). Results Data from 7657 children were analysed and improvements in PAQC scores were observed. Predicted mean PAQC score for all the hospitals at enrolment was 59.8% (95% CI: 54.7, 64.9) but showed a wide variation (variance 10.7%, 95% CI: 5.8, 19.6). Overall mean PAQC score increased by 13.8% (95% CI: 8.7–18.9, SD between hospitals: ±8.2) in the first 12 months, with an average 0.9% (95% CI: 0.3–1.5, SD ± 1.0) increase per month and plateaued thereafter, and changes were similar in two groups of hospitals joining the network at different times. Conclusion Adherence to guidelines for children admitted with DD can be improved through participation in a clinical network but improvement is limited, not uniform for all aspects of care and contexts and occurs early. Future research should address these issues. Objectif L'OMS recommande d'optimiser les interventions disponibles pour réduire le nombre de décès d'enfants de moins de cinq ans souffrant de diarrhée et de déshydratation (DD). Les réseaux cliniques peuvent aider à améliorer les pratiques dans de nombreux hôpitaux, mais l'expérience de tels réseaux est rare. Nous décrivons l'ampleur et les profils des changements dans les processus de prise en charge des enfants souffrant de DD au cours des trois premières années d'un réseau clinique. Méthodes Etude observationnelle chez les enfants âgés de 2 à 59 mois souffrant de DD et admis dans 13 hôpitaux participant au réseau clinique. Les processus de prise en charge individuelle des patients, y compris l'accord pour l'examen, le diagnostic et le traitement selon les directives de l'OMS, ont été combinés à l'aide du score composite (de 0 à 6) de la qualité des soins pédiatriques à l'admission (PAQC). Résultats Les données de 7.657 enf