The development of a quality information system: a case study of Mexico

One of the primary obstacles in the implementation of continuous quality im provement (CQI) programmes in developing countries is the lack of timely an d appropriate information for decentralized decision-making. The integrated quality information system (QIS) described herein demonstrates Mexico's un ique effort to package four separate, yet mutally reinforcing, tools for th e generation and use of quality-related information at all levels of the Me xican national health care system. The QIS is one element of the continuous quality improvement programme administered by the Secretariate of Health i n Mexico. Mexico's QIS was designed to be flexible and capable of adapting to local n eeds, while at the same time allowing for the standarization of health care quality assurance indicators, and subsequent ability to measure and compar e the quality performance of health facilities nationwide. The flexibility of the system extends to permit the optimal use of available data by health care managers at all levels of the health care system, as well as the gene ration of new information in important areas often neglected in more tradit ional information systems. Mexico's QIS consists of four integrated compone nts: 1) a set of client and provider surveys, to assess specific issues in the quality of health services delivered; 2) client and provider national s atisfaction surveys; 3) a sentinel health events strategy; and 4) a nationa l Comparative Performance Evaluation System, for use by the Secretariate of Health for the quality assessment of state and provincial health care serv ices (internal benchmarking). The QIS represents another step in Mexico's ongoing effort to use data for effective decision-making in the planning, monitoring and evaluation of ser vices delivered by the national health care system. The design and applicat ion of Mexico's QIS provides a model for decentralized decision-making that could prove useful for developing countries, where the effective use of qu ality indicators is often limited. Further, the system could serve as a mec hanism for motivating positive change in the way information is collected a nd used in the process of ensuring high quality health care service deliver y.