Blueprint for scalable laboratory driven quality management systems: Insights from tuberculosis diagnostic pilots in India.

BACKGROUND

Laboratory driven Quality Management Systems (QMS) are "sine qua non" for patient management. Weak QMS may lead to under/over diagnosing TB, unnecessary anti-TB treatment and delayed reporting of results that negatively impact patient care. QMS provides an effective mechanism for health system strengthening as it yields long-term benefits in the quality, cost-effectiveness, and sustainability of public health programs.

METHODS

Indian Council of Medical Research (ICMR), Central TB Division (CTD), National TB Elimination Program (NTEP) and SHARE INDIA introduced QMS as a pilot at four TB diagnostic laboratories. Baseline assessments ensured data collection to identify lacunae through standard checklists and provided recommendations for improvement. Capacity building of the healthcare cadre dovetailed to supportive supervision and mentoring ensured that gaps in QMS were plugged so that all laboratories achieved an excellent performance rating in endline assessment.

RESULTS

QMS improved quality of services for patient management and care. It strengthened TB case finding and improved documentation and laboratory performance.

CONCLUSIONS

Accuracy and reliability of laboratory service and overarching patient management can be improved by continuous quality improvement based on quality system essentials and QMS.