Comparative validity of three methods for assessment of the quality of primary health care.

OBJECTIVE: This study compared the sensitivity and specificity of three assessment methods to detect the performance of key clinical tasks by health workers in a primary care setting.
DESIGN: Health worker performance during patient encounters for acute respiratory infections, acute diarrhea and family planning counseling was assessed through checklist-based observation of the consultation, interview with the mother following the consultation, and review of the patient's clinical record. The results of each method regarding the performance of key tasks by health workers were compared to a 'gold standard', defined as the application of the observation checklist by observers with extensive quality assessment experience. Patient encounters were studied in three Ministry of Health facilities in the Department of Totonicapán, Guatemala, involving care by physicians, nurses and auxiliary staff
RESULTS: The three methods showed reasonably high levels of sensitivity (generally about 70%) for the detection of failures in the performance of most health worker tasks. The greatest problem experienced by each method related to specificity, i.e. capacity to recognize quality successes and only detect real failures.
CONCLUSION: Direct observation demonstrated the best overall balance of sensitivity and specificity. Exit interview of the mother demonstrated good sensitivity and better specificity than record review.