Project Lead(s): Madhukar Pai
India accounts for 25% of the global incidence of tuberculosis (TB). While ‘mystery clients’ (standardized patients [SP]) have been used to assess and ensure quality of care in low- and middle-income settings for health conditions (such as angina, asthma and dysentery) and for health services (such as family planning), this approach has not been tested with TB. The proof-of-concept for this project was to assess the utility of using SPs for measuring quality of TB care.
The pilot project used standardized patients posing as TB patients to evaluate quality of TB care in India.
Six case scenarios related to TB were developed for this pilot project and 17 individuals were trained as standardized patients to present consistent cases of illness to 100 consenting health providers in Delhi, India.
The project team was able to analyze data on 250 interactions between SPs and healthcare providers, and to assess quality of care provided.
The project showed the standardized patient (SP) methodology could be successfully applied to assess the quality of care for TB. Detection rates of the ‘mystery clients’ by providers was 4.7%, which is within the range of other standardized patient studies published in the literature.
The study showed low adherence by health providers to established standards of TB care, despite markedly high levels of knowledge. The study was published in the Lancet Infectious Diseases in November 2015.
Based on the promising findings from the pilot study, the research team has received a grant of $1.6 million from the Bill & Melinda Gates Foundation to conduct a large survey of the quality of TB care in two Indian cities. In this ongoing study, standardized patients have visited over 1,000 healthcare providers in Mumbai and Patna cities.