Enhancing the standard of medical care provided to patients is essential for bettering health outcomes and building public confidence amid outbreaks of infectious diseases. Although Quality Improvement (QI) approaches are widely recognized for advancing routine healthcare and strengthening health systems, documented applications during infectious disease emergencies remain limited. A modified Delphi technique was employed to develop a standardised evaluation instrument for assessing COVID-19 care quality in Sierra Leone. Four evaluation cycles were conducted from July 2020 to July 2021. Changes across these cycles relative to the initial baseline were analysed using a mixed-effects regression model, with reported coefficients and p-values.
In the Delphi procedure, 12 out of 14 experts agreed on the domains for inclusion in the instrument. The resulting tool comprised 50 items: 13 related to outcomes, 17 to processes, and 20 to inputs. Across four cycles, 94 evaluations were performed at 27 sites. Total scores rose by 8.75 (p < 0.01) in the second cycle, 10.67 (p < 0.01) in the third, and 2.17 (p = 0.43) in the fourth compared with baseline. Average overall scores at dedicated COVID-19 Treatment Centres consistently exceeded those at Hospital Isolation Units (p < 0.02) across all cycles. Notable progress occurred in domains covering coordination, diagnostics, staffing, infection prevention and control (IPC), nutrition, and support for vulnerable groups, whereas no significant gains were observed in oxygen supply, clinical processes, infrastructure, or medication domains. This study illustrates the practicality of designing a care quality evaluation tool and performing repeated national-level assessments during an active infectious disease outbreak. Substantial rises in quality-of-care metrics were observed in the second and third cycles relative to baseline, though these gains were not maintained. The adoption of QI methodologies alongside standardised assessment instruments is advised to elevate care standards in future outbreak responses.
