Mystery patients to assess and improve quality of TB care in India

Dr. PaiRI-MUHC investigator and member of the McGill International TB Centre, Dr. Madhukar Pai, has received two grants for a project that will, for the first time, use standardized patients (mystery clients) to assess the quality of tuberculosis (TB) care in India. The first phase of the study involves pilot testing the approach using a $100,000 grant from Grand Challenges Canada’s Stars in Global Health Program. It will subsequently be expanded to larger projects in two cities using a $1 million grant from the Bill and Melinda Gates Foundation.

Crowded street in India“India accounts for 25% of the global TB burden,” says Dr. Pai who is also an associate professor of epidemiology at McGill University. “Poorly managed TB drives the epidemic and generates drug-resistance. Thus, improving quality of TB care is high priority for TB control worldwide." 

The research project will use “mystery patients” posing as TB patients to evaluate the quality of care in both public and private sectors in India, and also include informal and unqualified providers. Patients will be trained to present a consistent case of illness to health providers. This approach is superior to direct observations, medical records and exit interviews. Although regarded as the gold standard, it has never been used to assess TB care. This technique might pinpoint the specific deficiencies in TB management and inform tailored policy interventions.

“Successfully implemented, this project will produce critical data required to understand key bottlenecks in the provision of care,” explains Dr. Pai. “This will lead to significant improvements in quality and reductions in diagnostic delays, which is a high priority for TB control, especially in urban hot spots with high prevalence of drug-resistant TB.” 

According to Dr. Pai, collecting and documenting this information for the private sector, where many providers lack medical qualifications, is particularly important since they account for the bulk of “first-contacts” in primary care.


Click on the following link to watch the video about the project: