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Table 1 Definitions of facility performance indicators

From: Effectiveness of educational outreach in infectious diseases management: a cluster randomized trial in Uganda

Program area and performance indicator Definition Reference
Emergency Triage, Assessment and Treatment (ETAT)  
1 Proportion of outpatients triaged Numerator: Number of outpatients triaged, meaning that the patient was classified as emergency, priority, or queue, or an emergency sign was noted in the triage section of the form. Denominator: Number of outpatients [50, 51]
2 Proportion of emergency and priority patients who were admitted, detained or referred Numerator: Number of emergency and priority patients admitted, detained or referred for care. Denominator: Number of outpatients classified as emergency or priority or an emergency sign was noted in the triage section of the form.
In line with World Health Organization guidelines, emergencies were defined as patients with one or more of the ABCDO triage signs (i.e., Airway; Breathing difficulty; Circulation / Coma / Convulsion / Confusion; Dehydration; and Other). Priorities were defined as patients with the 3TPR-MOB priority signs (i.e. Tiny baby (sick child of under 2 months of age); Temperature (child is very hot); Trauma or other urgent surgical condition; Pallor (severe); Poisoning; Pain (severe); Respiratory distress; Restless, lethargy or continuously irritable; Referral; Malnutrition (severe wasting); Oedema of both feet; and Burns) [52].
[50, 51]
3 Estimated proportion of emergency patients who received at least one appropriate treatment Numerator: Number of emergency patients who received at least one treatment prescribed according to ETAT standards where the standards were reported in Kinoti et al. (manuscript under review in PlosOne). For emergency patients who were prescribed treatment and data on drug availability were missing, we applied the “in-stock” rate for patients with those data. Denominator: Number of outpatients classified as emergency or an emergency sign was noted in the triage section of the form [50, 51]
Case management of fever and malaria  
4 Proportion of malaria suspects with a malaria test result recorded Numerator: Number of malaria suspects with a result for a laboratory test or rapid diagnostic test for malaria, where the definition of a malaria suspect was reported in Mbonye et al. [37]. Denominator: Number of malaria suspects [16, 39, 53]
5 Estimated proportion of malaria cases who received an appropriate antimalarial Numerator: Number of outpatients treated with appropriate anti-malarial(s), where appropriate antimalarial treatments were quinine and four artemisinin-based combination therapies reported in Mbonye et al. [37]. For patients who were prescribed an antimalarial and data on drug availability were missing, we applied the “in-stock” rate for patients with those data. Denominator: Number of outpatients treated for malaria [16, 39, 53]
6 Proportion of patients with a negative malaria test result who were prescribed an antimalarial Numerator: Number of patients with a negative malaria test result prescribed any antimalarial including appropriate treatments and those that do not comply with Ugandan national guidelines. Denominator: Number of patients with a negative malaria test result [16, 39, 53]
7 Proportion of patients with a positive malaria test result who were prescribed an antibiotic Numerator: Number of patients with a positive malaria test result prescribed any antibiotic(s), where antibiotic treatment refers to the 31 drugs listed in Mbonye et al. [37]. Denominator: Number of patients with a positive malaria test result [16, 39, 53]
Case management of respiratory illness  
8 Proportion of pneumonia suspects aged under 5 years assessed for pneumonia Numerator: Number of child pneumonia suspects with at least one of the three following assessment results recorded: 1) abnormal chest sounds, 2) chest in-drawing, and 3) rapid breaths per minute. A pneumonia suspect was defined as any child aged under five years presenting with cough or who received a diagnosis of “pneumonia” or “cough/cold no pneumonia”. Denominator: Number of child pneumonia suspects. Note: The definition of suspect focused on children with cough; difficulty in breathing was inadvertently omitted from the form. [54]
9 Estimated proportion of patients aged under 5 years diagnosed with pneumonia who received appropriate antibiotic treatment Numerator: Number of children diagnosed with pneumonia treated with appropriate antibiotic, where appropriate antibiotic treatment referred to six drugs on the revised Medical Form 5: amoxicillin, benzyl penicillin, erythromycin, chloramphenicol, gentamicin, cotrimoxazole, and 11 other drugs that were specified: ampicillin, azithromycin, cefixime, ceftriaxone, cefuroxime, co-amoxiclav, gatifloxacin, levofloxacin, penicillin, phenoxymethylpenicillin, ampiclox (amoxicillin and cloxacillin). For patients who were prescribed an antibiotic and data on drug availability were missing, we applied the “in-stock” rate for patients with those data. Denominator: Number of children diagnosed with pneumonia [54]
10 Proportion of TB suspects with a first Acid-Fast Bacilli (AFB) smear result Numerator: Number of TB suspects who get a first AFB smear result, where TB suspect was defined as anyone with a history of: cough for longer than two weeks, cough for less than two weeks and night sweats, cough for less than two weeks and weight loss, TB test ordered, new TB diagnosis, started on initial TB treatment, or referred for TB treatment. For children, the definition extended to anyone who had contact with someone with TB. Denominator: Number of TB suspects. Note: The definition of TB suspect is from the Intensified Case Finding Form for People Living with HIV, contacts of smear positive patients, and HIV care settings [55]. Increasing AFB smears among TB suspects will increase case detection, but this is not the case detection indicator used by the Stop TB program [56]. [52, 5658]
11 Estimated proportion of patients with AFB smear negative results who received empiric treatment for acute respiratory infection Numerator: Number of people with AFB smear negative test results who received empiric treatment for acute respiratory infection, including amoxicillin, doxycycline, or erythromycin. For patients who were prescribed an antibiotic and data on drug availability were missing, we applied the “in-stock” rate for patients with those data. Denominator: Number of people with AFB smear negative result [52, 5658]
HIV testing and prevention  
16 Proportion of patients with an HIV test result recorded Numerator: Number of outpatients who were not TB suspects with an HIV test result recorded. TB suspect is defined for Indicator 10. Denominator: Number of outpatients who were not TB suspects. Note: This indicator included anyone who said they knew their HIV status in the protocol, and was revised to comply with the MOH definition based strictly on a laboratory test result on the day of the outpatient visit. [58]
   Numerator: Number of TB suspects with an HIV test result recorded. TB suspect is defined for Indicator 10. Denominator: Number of TB suspects. Note: This indicator included anyone who said they knew their HIV status in the protocol, and was revised as described above.  
  1. Abbreviations: AFB Acid-fast bacilli, CQI Continuous Quality Improvement, HIV Human Immunodeficiency Syndrome, MOH Ministry or Health