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Table 1 Examples of monitoring systems in the healthcare system

From: SUPPORT Tools for Evidence-informed Policymaking in health 18: Planning monitoring and evaluation of policies

Scaling up provision of antiretroviral therapy (ART) in Malawi[3]
When Malawian health authorities decided to make ART available to a large proportion of the HIV-positive population, a system was put in place to monitor the implementation of this new policy. The principles of the system are based on the WHO's approach to the monitoring of national tuberculosis programmes. Each patient who starts on ART is given an identity card with a unique identity number, and this is kept at the clinic. The information collected from new patients includes their name, address, age, height, the name of their guardian, and the reason for starting ART. Patients are asked to attend each month to collect their medication. During their visit, their weight is recorded and they are asked about their general health, ambulatory status, work, and any drug side effects. Pill counts are also undertaken and recorded as a way of ensuring drug adherence. In addition, the following standardised monthly outcomes are recorded using the following categories:
Alive: Patient is alive and has collected his/her own 30-day supply of drugs
Dead: Patient has died while on ART
Defaulted: Patient has not been seen at all for a period of 3 months
Stopped: Patient has stopped treatment completely either due to side effects or for other reasons
Transfer-out: Patient has transferred out permanently to another treatment
Data collected as part of the Malawian monitoring system of the ART rollout may be analysed and used in a variety of ways. Comparisons can be made of treatment outcomes for patients who were recruited at different times. If, for example, the rate of switching from first- to second-line regimens increases, or rates of mortality do likewise, an increase in drug resistance to the first-line regimen could be the cause. If the rate of deaths or defaulters declines, this could indicate that the management of the ART treatment programme is improving. If outcomes are particularly poor in certain geographic areas or clinics, action may need to be taken to address this.
Lung cancer surgery in Denmark[4]
Danish authorities issued national clinical practice guidelines for the management of lung cancer prompted by poor outcomes for patients who underwent lung cancer surgery. To monitor the implementation of the guidelines, a register of lung cancer patients was established which included specific information about those patients undergoing surgery. Indicators selected by the Danish Lung Cancer Registry include the extent (or 'stage') of cancer in the body, the surgical procedure used, any complications that occurred, and the survival outcome.
Data from the Danish Lung Cancer Registry are used, among other reasons, to monitor whether national recommendations for lung cancer surgery are being followed. Local, regional, and national audits are performed with the purpose of identifying problems or barriers that may impede adherence to the national guidelines. Based on these findings, specific strategies are proposed for quality improvement.