In-patient Tuberculosis (TB) Treatment in Armenia: Establishment of Continuous Quality Improvement System – A Needs Assessment

Funding Agency: Armenian Medical Fund


This was a collaborative work of the Avedisian Onanian Center for Health Services Research & Development with the National TB Control Center (NTCC) of the RA Ministry of Health and with financial assistance from the Armenian Medical Fund. The study team conducted needs assessment of the NTCC’s diagnostic and inpatient treatment services in the TB inpatient facility, aimed to develop a multi-year plan on introducing continuous quality improvement system in the NTCC. We assessed the largest TB inpatient facility in Armenia, located in Abovyan city that provides inpatient care to around 3,000 TB patients annually to evaluate its compliance with the Joint Commission International Accreditation Standards for Hospitals, International Standards for TB Care, and WHO framework for conducting TB program reviews. Data was collected through 24 in-depth interviews and eight standardized checklists to explore practices of healthcare professionals, assess inpatient treatment experience of patients and their family members, evaluate the facility environmental conditions and define the level of policies applied. It was analyzed using scoring system converted to percentages for both patient-centered and organization-management functions. We have found that in practice there are several processes that are not standardized and consistent leading to meet the international and local standards minimally: Quality Improvement and Patient Safety (25%), Patient and Family Education (26%); partially: TB-Tobacco Control (35%), Patient and Family Rights (39%), Assessment of Patients (61%), and Medication Management and Use (62%), Staff Qualifications and Education (42%), and Governance, Leadership and Direction (53%); or satisfactory: Patient care (71%), Prevention and Control of Infection (75%), Access and Continuity of Care (87%), and Management of Communication and Information (79%). These functions require some, several or major improvements by implementing interventions on two levels of the organization’s operation: structure-related improvements (development of policies, procedures, written documentations and establishment of modern infrastructures) and process-related improvements (actions towards improving the patient care processes). Furthermore, the hospital-wide organizational culture should undergo several changes to go in-line with the notion of healthcare quality and patient safety. Findings of this assessment were submitted /presented in international conferences. Currently the research team is working on manuscripts for publication in peer-reviewed journals.