Using adaptive e-learning and smartphones to improve newborn and pediatric admission care outcomes in Mwanza, Tanzania

Project Summary/Abstract: In sub-Saharan Africa, low quality care at health facilities contributes to over 1 million child deaths each year. Provider knowledge is a major contributor, but conventional provider educational methods have proven limited due to fixed, universal content; limited geographical reach; and no refresher learning over time. Our long-term

goal is to develop a highly effective education strategy to increase provider proficiency with evidence-based interventions that can be scaled-up worldwide. To this end, we have piloted a novel adaptive eLearning (elec- tronic media and devices that adjust to the learner’s needs) intervention called PACE. The overall objectives of

this application are to 1) determine the effect of incorporating Tailored Skills Practice and rapid content devel- opment process into PACE and 2) finalize an implementation strategy for PACE, including measures of pro- vider performance and patient outcomes at all facility types in Mwanza, Tanzania. The central hypothesis is

that adaptive eLearning blended with in-person skills training that is continuously contextualized to facility needs will increase the quality of care. Our pilot studies of PACE have shown significant improvement in pro- vider knowledge rates, providing the rationale that adaptive eLearning represents a potential solution to over-

come known limitations of current educational methods to greatly increase the impact of education on provider proficiency. The specific aims of our two phased approach will: 1) determine if the addition of Tailored Skills Training increases refresher knowledge assignment completion >60% (R21); 2) determine whether rapid con-

tent development process using Tanzanian based personnel can disseminate content within 90 days (R21); 3) Validate whether PACE implementation is feasible across all facility types (R33); and 4) Establish and validate a system to derive provider specific pediatric admission quality of care (PAQC) scores for future PACE effec-

tiveness study. In our R21, we will recruit clinical champions to conduct Tailored Skills Practice at health cen- ters, recruit a local content engineer (CE) and initiate quarterly meetings with multi-level leadership to continu- ously contextualize PACE to facility needs. For the R33, we will expand PACE to all facility types and explore

generating provider specific PAQC scores using both electronic health record data extraction and prospective clinical auditing. Our innovative mixed methods approach will provide a significant framework for the optimal integration of eLearning into tailored skills trainings and clinical auditing for providers in LMICs. Development

of an effective pediatric acute care provider education strategy and system to derive provider level perfor- mance and patient outcome metrics will build a foundation for a large-scale implementation study in Tanzania. If successful, this work will improve child global health significantly and broadly advance our knowledge and

understanding of provider education and quality of care worldwide.