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Outcome Measurement at a Ugandan Referral Hospital: Validation of the Mbarara Surgical Services Quality Assurance Database

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Abstract

Background

Five billion people lack access to surgery. Accurate and complete data have been identified as essential to the global scale-up of perioperative care. This study retrospectively validates the Mbarara Surgical Services Quality Assurance Database (SQUAD), an electronic outcomes database at a Ugandan secondary referral hospital.

Methods

SQUAD data were compared to paper records from August 2013 to January 2017. To assess data entry accuracy, two researchers independently extracted 24 patient variables from 170 charts. To assess completeness of patient capture, SQUAD entries were compared to a sample of charts returned to the Medical Records Department, and to a sample of entries in ward and operating room logbooks. Two-tailed binomial proportions with 95% CI were calculated from the comparative results of patient observations, against a predefined accuracy of 0.85–0.95.

Results

Agreement between completed validation observations from charts and SQUAD data was 91.5% (n = 3734/4080 data points). Binomial tests indicated that 15 variables had higher than 95% accuracy. A total 19 of 24 variables had ≥ 85% accuracy. The completeness of SQUAD patient capture was 98.2% (n = 167/170) of charts returned to the Medical Records Department, 97.5% (n = 198/203) of operating logbook entries, and 100% (n = 111/111) of ward logbook entries, respectively.

Conclusion

SQUAD closely reflects the primary surgical and anaesthetic data at a Ugandan secondary hospital. Data accuracy of key variables and completeness of population capture were comparable to those of databases in high-income countries and outperformed those of other low- and middle-income countries.

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Acknowledgements

The authors acknowledge the work of the SQUAD clerks and the staff at the Medical Records Department at MRRH, whose work underlies the ultimate data quality of SQUAD. Data from this study can be made available upon reasonable request.

Funding

Funding for the database or for this publication has been provided by GE Foundation, Milton Foundation, Kletjian Foundation, MGH Department of Anesthesia, Critical Care and Pain Medicine, Göran and Erik Ennerfelt Foundation, Swedish Society for Medicine, and Fredrik Lindström Foundation.

Author information

Authors and Affiliations

  1. Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA

    Gustaf Drevin, Katherine Albutt & Paul Firth

  2. Department for Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

    Gustaf Drevin

  3. Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA

    Katherine Albutt

  4. Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda

    Moris Baluku & Stephen Ttendo

  5. Department of Surgery, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda

    Caleb Tuhumwiire

  6. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA

    Hao Deng, Vicki Modest & Paul Firth

  7. Harvard-Mbarara University of Science and Technology Collaborative, Mbarara, Uganda

    Nicholas Musinguzi

  8. Department of Obstetrics and Gynaecology, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda

    Joseph Ngonzi

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  1. Gustaf Drevin
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Correspondence to Paul Firth.

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Drevin, G., Albutt, K., Baluku, M. et al. Outcome Measurement at a Ugandan Referral Hospital: Validation of the Mbarara Surgical Services Quality Assurance Database. World J Surg 44, 2550–2556 (2020). https://doi.org/10.1007/s00268-020-05537-8

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  • DOI: https://doi.org/10.1007/s00268-020-05537-8

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