Alistair Kwan
Biographic Data
| ID | 123924 |
|---|---|
| NAME | Alistair Kwan |
| GIVEN NAMES | Alistair |
| FAMILY NAME | Kwan |
| SIGNATURE | KWAN A |
| AFFILIATIONS | University of California, San Francisco |
| ORCID | 0000-0003-4889-9433 |
| VERIFIED | Yes |
| TOTAL WORKS | 16 |
| TOTAL CITATIONS | 8 |
| AUTHOR COUNT | 16 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2011 |
| LATEST PUBLICATION YEAR | 2023 |
| H-INDEX | 2 |
Deception and informed consent in studies with incognito simulated standardized patients
Simulated standardized patients (SPs) are trained individuals who pose incognito as people seeking treatment in a health care setting. With the method’s increasing use and popularity, we propose some standards to adapt the method to contextual considerations of feasibility, and we discuss current issues with the SP method and the experience of consent and ethical research in international SP studies. Since a foundational discussion of the researc…
Use of standardised patients to assess tuberculosis case management by private pharmacies in Patna, India
As the first point of care for many healthcare seekers, private pharmacies play an important role in tuberculosis (TB) care. However, previous studies in India have showed that private pharmacies commonly dispense symptomatic treatments and broad-spectrum antibiotics over-the-counter (OTC), rather than referring patients for TB testing. Such inappropriate management by pharmacies can delaye TB diagnosis. We assessed medical advice and OTC drug di…
Can a private sector engagement intervention that prioritizes pro-poor strategies improve healthcare access and quality? A randomized field experiment in Kenya
Private sector engagement in health reform has been suggested to help reduce healthcare inequities in sub-Saharan Africa, where populations with the most need seek the least care. We study the effects of African Health Markets for Equity (AHME), a cluster randomized controlled trial carried out in Kenya from 2012 to 2020 at 199 private health clinics. AHME included four clinic-level interventions: social health insurance, social franchising, Safe…
Prescribing practices for presumptive TB among private general practitioners in South Africa
INTRODUCTION: Medicine prescribing practices are integral to quality of care for leading infectious diseases such as tuberculosis (TB). We describe prescribing practices in South Africa's private health sector, where an estimated third of people with TB symptoms first seek care. METHODS: Sixteen standardised patients (SPs) presented one of three cases during unannounced visits to private general practitioners (GPs) in Durban and Cape Town: TB sym…
Tuberculosis diagnosis and management in the public versus private sector
BACKGROUND: There are few rigorous studies comparing quality of tuberculosis (TB) care in public versus private sectors. METHODS: We used standardised patients (SPs) to measure technical quality and patient experience in a sample of private and public facilities in Mumbai. RESULTS: SPs presented a 'classic, suspected TB' scenario and a 'recurrence or drug-resistance' scenario. In the private sector, SPs completed 643 interactions. In the public s…
Tuberculosis care quality in urban Nigeria
Nigeria has a high burden of tuberculosis (TB) and low case detection rates. Nigeria’s large private health sector footprint represents an untapped resource for combating the disease. To examine the quality of private sector contributions to TB, the USAID-funded Sustaining Health Outcomes through the Private Sector (SHOPS) Plus program evaluated adherence to national standards for management of presumptive and confirmed TB among the clinical faci…
Covid-19 outbreak in a state prison
Our adapted framework facilitates systematically assessing prison-based infectious disease outbreaks and multi-level interventions. We find implementing some recommended public health strategies may have contributed to outbreak containment. However, even with a rapidly mobilized, inter-institutional response, failure to decarcerate created an overreliance on chance conditions. This left the facility vulnerable to future catastrophic outbreaks and…
Implementing Quality of Care Measures
Implementing Quality of Care Measures: Lessons from a Standardized Patient Study in Seven Provinces of China Ada KwanPhD, MHS Affiliation Ada Kwan is with the Department of Medicine at the University of California, San Francisco School of Medicine. CopyRightCorrespondence should be sent to Ada Kwan, PhD, MHS, University of California, San Francisco, School of Medicine, 1001 Potrero Avenue, San Francisco, CA 94110 (e-mail: [email protected]). Repr…
Simulated patients and their reality
Simulated standardized patients (SSP) have emerged as close to a 'gold standard' for measuring the quality of clinical care. This method resolves problems of patient mix across healthcare providers and allows care to be benchmarked against preexisting standards. Nevertheless, SSPs are not real patients. How, then, should data from SSPs be considered relative to clinical observations with 'real' patients in a given health system? Here, we reject t…
Quality of care for tuberculosis and HIV in the private health sector
BACKGROUND: South Africa has high burdens of tuberculosis (TB) and TB-HIV, yet the quality of patient care in the private sector is unknown. We describe quality of TB and TB-HIV care among private general practitioners (GPs) in two South African cities using standardised patients (SPs). METHODS: Sixteen SPs presented one of three cases during unannounced visits to private GPs in selected high-TB burden communities in Durban and Cape Town: case 1,…
Ten Urgent Priorities Based on Lessons Learned From More Than a Half Million Known Covid-19 Cases in US Prisons
COVID-19 is ravaging US prisons. Prison residents and staff must be prioritized for vaccination, but a rapidly mutating virus and high rates of continued spread require an urgent, coordinated public health response. Based on knowledge accumulated from the pandemic thus far, we have identified 10 pressing public health priorities for responding to COVID-19 in prisons: (1) accelerate population reduction coupled with community reentry support, (2) …
Antibiotic overuse in the primary health care setting
INTRODUCTION: Determining whether antibiotic prescriptions are inappropriate requires knowledge of patients' underlying conditions. In low-income and middle-income countries (LMICs), where misdiagnoses are frequent, this is challenging. Additionally, such details are often unavailable for prescription audits. Recent studies using standardised patients (SPs) offer a unique opportunity to generate unbiased prevalence estimates of antibiotic overuse…
How to do (or not to do) … using the standardized patient method to measure clinical quality of care in LMIC health facilities
Standardized patients (SPs), i.e. mystery shoppers for healthcare providers, are increasingly used as a tool to measure quality of clinical care, particularly in low- and middle-income countries where medical record abstraction is unlikely to be feasible. The SP method allows care to be observed without the provider’s knowledge, removing concerns about the Hawthorne effect, and means that providers can be directly compared against each other. How…
Seven Ways of Looking at a Data Set
A literary theorist, a biologist, an historian, a writing studies scholar, and a poet walk into a wine bar. The poet says, "I've got a stack of 1,223 handwritten questionnaire responses here in my bag; would you like to have a look?" The others reply, "Sure. Let's see what we can learn here." Descending from their respective disciplinary perches, they all gather around a table and start sifting through the questionnaires, which chronicle the writ…
Vernier scales and other early devices for precise measurement
Vernier scales have been extensively used since the 17th century. They replaced the Nonius scale, a unpopular device due to difficulty in its fabrication and use, and they coexisted alongside other types of scales that increased measurement precision and accuracy in complementary ways. I suggest that the success of Vernier and diagonal scales is due not only to simplicity of fabrication, but also to their exploitation of visual hyperacuities.
Tycho's Talisman
Renaissance Vitruvianism provides a broad context in which to situate the architecture of Tycho Brahe's Uraniborg, but fails to account for the motivation behind Tycho's design, for how Tycho knew Vitruvian design principles, and for any of Uraniborg's specific features. Identifying Uraniborg as a Palladian design fares even worse. Some of Uraniborg's features can, however, be understood in terms of talismanic ideas such as those circulating in s…
Simulated patients and their reality
Simulated standardized patients (SSP) have emerged as close to a 'gold standard' for measuring the quality of clinical care. This method resolves problems of patient mix across healthcare providers and allows care to be benchmarked against preexisting standards. Nevertheless, SSPs are not real patients. How, then, should data from SSPs be considered relative to clinical observations with 'real' patients in a given health system? Here, we reject t…
Ten Urgent Priorities Based on Lessons Learned From More Than a Half Million Known Covid-19 Cases in US Prisons
COVID-19 is ravaging US prisons. Prison residents and staff must be prioritized for vaccination, but a rapidly mutating virus and high rates of continued spread require an urgent, coordinated public health response. Based on knowledge accumulated from the pandemic thus far, we have identified 10 pressing public health priorities for responding to COVID-19 in prisons: (1) accelerate population reduction coupled with community reentry support, (2) …
Seven Ways of Looking at a Data Set
A literary theorist, a biologist, an historian, a writing studies scholar, and a poet walk into a wine bar. The poet says, "I've got a stack of 1,223 handwritten questionnaire responses here in my bag; would you like to have a look?" The others reply, "Sure. Let's see what we can learn here." Descending from their respective disciplinary perches, they all gather around a table and start sifting through the questionnaires, which chronicle the writ…
Vernier scales and other early devices for precise measurement
Vernier scales have been extensively used since the 17th century. They replaced the Nonius scale, a unpopular device due to difficulty in its fabrication and use, and they coexisted alongside other types of scales that increased measurement precision and accuracy in complementary ways. I suggest that the success of Vernier and diagonal scales is due not only to simplicity of fabrication, but also to their exploitation of visual hyperacuities.
Tycho's Talisman
Renaissance Vitruvianism provides a broad context in which to situate the architecture of Tycho Brahe's Uraniborg, but fails to account for the motivation behind Tycho's design, for how Tycho knew Vitruvian design principles, and for any of Uraniborg's specific features. Identifying Uraniborg as a Palladian design fares even worse. Some of Uraniborg's features can, however, be understood in terms of talismanic ideas such as those circulating in s…
Seven Ways of Looking at a Data Set
A literary theorist, a biologist, an historian, a writing studies scholar, and a poet walk into a wine bar. The poet says, "I've got a stack of 1,223 handwritten questionnaire responses here in my bag; would you like to have a look?" The others reply, "Sure. Let's see what we can learn here." Descending from their respective disciplinary perches, they all gather around a table and start sifting through the questionnaires, which chronicle the writ…
How to do (or not to do) … using the standardized patient method to measure clinical quality of care in LMIC health facilities
Standardized patients (SPs), i.e. mystery shoppers for healthcare providers, are increasingly used as a tool to measure quality of clinical care, particularly in low- and middle-income countries where medical record abstraction is unlikely to be feasible. The SP method allows care to be observed without the provider’s knowledge, removing concerns about the Hawthorne effect, and means that providers can be directly compared against each other. How…
Antibiotic overuse in the primary health care setting
INTRODUCTION: Determining whether antibiotic prescriptions are inappropriate requires knowledge of patients' underlying conditions. In low-income and middle-income countries (LMICs), where misdiagnoses are frequent, this is challenging. Additionally, such details are often unavailable for prescription audits. Recent studies using standardised patients (SPs) offer a unique opportunity to generate unbiased prevalence estimates of antibiotic overuse…
Quality of care for tuberculosis and HIV in the private health sector
BACKGROUND: South Africa has high burdens of tuberculosis (TB) and TB-HIV, yet the quality of patient care in the private sector is unknown. We describe quality of TB and TB-HIV care among private general practitioners (GPs) in two South African cities using standardised patients (SPs). METHODS: Sixteen SPs presented one of three cases during unannounced visits to private GPs in selected high-TB burden communities in Durban and Cape Town: case 1,…
Ten Urgent Priorities Based on Lessons Learned From More Than a Half Million Known Covid-19 Cases in US Prisons
COVID-19 is ravaging US prisons. Prison residents and staff must be prioritized for vaccination, but a rapidly mutating virus and high rates of continued spread require an urgent, coordinated public health response. Based on knowledge accumulated from the pandemic thus far, we have identified 10 pressing public health priorities for responding to COVID-19 in prisons: (1) accelerate population reduction coupled with community reentry support, (2) …
Prescribing practices for presumptive TB among private general practitioners in South Africa
INTRODUCTION: Medicine prescribing practices are integral to quality of care for leading infectious diseases such as tuberculosis (TB). We describe prescribing practices in South Africa's private health sector, where an estimated third of people with TB symptoms first seek care. METHODS: Sixteen standardised patients (SPs) presented one of three cases during unannounced visits to private general practitioners (GPs) in Durban and Cape Town: TB sym…
Tuberculosis diagnosis and management in the public versus private sector
BACKGROUND: There are few rigorous studies comparing quality of tuberculosis (TB) care in public versus private sectors. METHODS: We used standardised patients (SPs) to measure technical quality and patient experience in a sample of private and public facilities in Mumbai. RESULTS: SPs presented a 'classic, suspected TB' scenario and a 'recurrence or drug-resistance' scenario. In the private sector, SPs completed 643 interactions. In the public s…
Tuberculosis care quality in urban Nigeria
Nigeria has a high burden of tuberculosis (TB) and low case detection rates. Nigeria’s large private health sector footprint represents an untapped resource for combating the disease. To examine the quality of private sector contributions to TB, the USAID-funded Sustaining Health Outcomes through the Private Sector (SHOPS) Plus program evaluated adherence to national standards for management of presumptive and confirmed TB among the clinical faci…
Covid-19 outbreak in a state prison
Our adapted framework facilitates systematically assessing prison-based infectious disease outbreaks and multi-level interventions. We find implementing some recommended public health strategies may have contributed to outbreak containment. However, even with a rapidly mobilized, inter-institutional response, failure to decarcerate created an overreliance on chance conditions. This left the facility vulnerable to future catastrophic outbreaks and…
Implementing Quality of Care Measures
Implementing Quality of Care Measures: Lessons from a Standardized Patient Study in Seven Provinces of China Ada KwanPhD, MHS Affiliation Ada Kwan is with the Department of Medicine at the University of California, San Francisco School of Medicine. CopyRightCorrespondence should be sent to Ada Kwan, PhD, MHS, University of California, San Francisco, School of Medicine, 1001 Potrero Avenue, San Francisco, CA 94110 (e-mail: [email protected]). Repr…
Simulated patients and their reality
Simulated standardized patients (SSP) have emerged as close to a 'gold standard' for measuring the quality of clinical care. This method resolves problems of patient mix across healthcare providers and allows care to be benchmarked against preexisting standards. Nevertheless, SSPs are not real patients. How, then, should data from SSPs be considered relative to clinical observations with 'real' patients in a given health system? Here, we reject t…
Deception and informed consent in studies with incognito simulated standardized patients
Simulated standardized patients (SPs) are trained individuals who pose incognito as people seeking treatment in a health care setting. With the method’s increasing use and popularity, we propose some standards to adapt the method to contextual considerations of feasibility, and we discuss current issues with the SP method and the experience of consent and ethical research in international SP studies. Since a foundational discussion of the researc…
Use of standardised patients to assess tuberculosis case management by private pharmacies in Patna, India
As the first point of care for many healthcare seekers, private pharmacies play an important role in tuberculosis (TB) care. However, previous studies in India have showed that private pharmacies commonly dispense symptomatic treatments and broad-spectrum antibiotics over-the-counter (OTC), rather than referring patients for TB testing. Such inappropriate management by pharmacies can delaye TB diagnosis. We assessed medical advice and OTC drug di…
Can a private sector engagement intervention that prioritizes pro-poor strategies improve healthcare access and quality? A randomized field experiment in Kenya
Private sector engagement in health reform has been suggested to help reduce healthcare inequities in sub-Saharan Africa, where populations with the most need seek the least care. We study the effects of African Health Markets for Equity (AHME), a cluster randomized controlled trial carried out in Kenya from 2012 to 2020 at 199 private health clinics. AHME included four clinic-level interventions: social health insurance, social franchising, Safe…
Medicine (13 works) · Nursing (10 works) · Health care (8 works) · Public health (8 works) · Environmental health (7 works) · Family medicine (6 works) · Antibiotic Use and Resistance (4 works) · Economic growth (4 works) · Pathology (4 works) · Political science (4 works)