ArticleBMJ global health2017
Use of standardised patients to assess quality of healthcare in Nairobi, Kenya: a pilot, cross-sectional study with international comparisons.
Article in BMJ global health, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 2 of them syntheses that pooled it.
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Who cites it
59 citing papers in PubMed, 2 syntheses or guidelines pooled it, 107 citations in OpenAlex.
- Comparing the use of direct observation, standardized patients and exit interviews in low- and middle-income countries: a systematic review of methods of assessing quality of primary care.Health policy and planning · 2021Pooled it
- How to do (or not to do) … using the standardized patient method to measure clinical quality of care in LMIC health facilities.Health policy and planning · 2019Pooled it
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- Effect of a multifaceted intervention to improve clinical quality of care through stepwise certification (SafeCare) in health-care facilities in Tanzania: a cluster-randomised controlled trial.The Lancet. Global health · 2021Trial
- Evaluating the implementation of the vignettes-based injury care process assessment tool in low- and middle-income countries settings.BMC health services research · 2026Article
- Using Unannounced Standardized Patients to Assess the Quality of Tuberculosis Care and Antibiotic Prescribing: A Cross-Sectional Study on a Low/Middle-Income Country, Pakistan.Antibiotics (Basel, Switzerland) · 2025Article
- Private sector tuberculosis care quality during the COVID-19 pandemic: a repeated cross-sectional standardised patients study of adherence to national TB guidelines in urban Nigeria.BMJ global health · 2024Article
- General dentists' treatment plans in response to cosmetic complains; a field study using unannounced-standardized-patient.Heliyon · 2024Article
- The impact of a multi-faceted intervention on non-prescription dispensing of antibiotics by urban community pharmacies in Indonesia: a mixed methods evaluation.BMJ global health · 2024Article
- Drug-resistant tuberculosis: a persistent global health concern.Nature reviews. Microbiology · 2024Review
- Impact of the COVID-19 pandemic on quality of tuberculosis care in private facilities in Bandung, Indonesia: a repeated cross-sectional standardized patients study.BMC public health · 2024Article
- Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa.PloS one · 2024Article
- Evaluation of Ebola virus disease surveillance system capability to promptly detect a new outbreak in Liberia.BMJ global health · 2023Article
- Examining the factors associated with inpatients' perception of overtreatment in Korea: a cross-sectional study.BMC health services research · 2023Article
- Article
- Does increased provider effort improve quality of care? Evidence from a standardised patient study on correct and unnecessary treatment.BMC health services research · 2023Article
- Perceived quality of care and choice of healthcare provider in informal settlements.PLOS global public health · 2023Article
- Practice regarding tuberculosis care among physicians at private facilities: A cross-sectional study from Vietnam.PloS one · 2023Article
- Secret shopper studies: an unorthodox design that measures inequities in healthcare access.Archives of public health = Archives belges de sante publique · 2022Article
Corrections and comments
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Authors and funding
10 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe quality of clinical care can be reliably measured in multiple settings using standardised patients (SPs), but this methodology has not been extensively used in Sub-Saharan Africa. This study validates the use of SPs for a variety of tracer conditions in Nairobi, Kenya, and provides new results on the quality of care in sampled primary care clinics.
methodsWe deployed 14 SPs in private and public clinics presenting either asthma, child diarrhoea, tuberculosis or unstable angina. Case management guidelines and checklists were jointly developed with the Ministry of Health. We validated the SP method based on the ability of SPs to avoid detection or dangerous situations, without imposing a substantial time burden on providers. We also evaluated the sensitivity of quality measures to SP characteristics. We assessed quality of practice through adherence to guidelines and checklists for the entire sample, stratified by case and stratified by sector, and in comparison with previously published results from urban India, rural India and rural China.
resultsAcross 166 interactions in 42 facilities, detection rates and exposure to unsafe conditions were both zero. There were no detected outcome correlations with SP characteristics that would bias the results. Across all four conditions, 53% of SPs were correctly managed with wide variation across tracer conditions. SPs paid 76% less in public clinics, but proportions of correct management were similar to private clinics for three conditions and higher for the fourth. Kenyan outcomes compared favourably with India and China in all but the angina case.
conclusionsThe SP method is safe and effective in the urban Kenyan setting for the assessment of clinical practice. The pilot results suggest that public providers in this setting provide similar rates of correct management to private providers at significantly lower out-of-pocket costs for patients. However, comparisons across countries are sensitive to the tracer condition considered.
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