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Ross S Bailie - One of the best experts on this subject based on the ideXlab platform.
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sustained participation in annual Continuous Quality Improvement activities improves Quality of care for aboriginal and torres strait islander children
Journal of Paediatrics and Child Health, 2018Co-Authors: Daniel Mcaullay, Ross S Bailie, Kimberley Mcauley, Veronica Mathews, Peter Jacoby, Karen Gardner, Beverly Sibthorpe, Natalie A Strobel, Karen EdmondAbstract:Aim To determine whether participation in the Continuous Quality Improvement (CQI) Audit and Best Practice for Chronic Disease programme improved care and outcomes for Indigenous children. Methods Data were collected from 59 Australian primary health-care centres providing services to Indigenous people and participating in the programme (February 2008 and December 2013). Indigenous children aged less than 2 years and centres that completed three or more consecutive annual audits within the 6-year study period were included. Crude and adjusted logistic generalised estimating equation models were used to examine the effect of year of audit on the delivery of care. Odds ratio (OR) and 95% confidence interval (CI) were calculated. Outcomes were related to age-relevant health issues, including prevention and early intervention. These included administrative, health check, anticipatory guidance and specific health issues. Results During the audit period, there were 2360 files from 59 centres. Those that had a recall recorded, improved from 84 to 95% (OR 2.44, 95% CI 1.44–4.11). Hearing assessments improved from 52 to 89% (OR 1.37, 95% CI 1.22–1.54). Improvement in anticipatory guidance, treatment and follow-up of medical conditions was almost universal. Conclusion We documented significant Improvements in Quality of care of Indigenous children. Outcomes and their corresponding treatment and follow-ups improved over time. This appears to be related to services participating in annual CQI activities. However, these services may be more committed to CQI than others and therefore possibly better performing.
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wide variation in sexually transmitted infection testing and counselling at aboriginal primary health care centres in australia analysis of longitudinal Continuous Quality Improvement data
BMC Infectious Diseases, 2017Co-Authors: Barbara Nattabi, Veronica Matthews, Jodie Bailie, Alice R Rumbold, David Scrimgeour, Gill Schierhout, James Ward, John M Kaldor, Sandra C Thompson, Ross S BailieAbstract:Background Chlamydia, gonorrhoea and syphilis are readily treatable sexually transmitted infections (STIs) which continue to occur at high rates in Australia, particularly among Aboriginal Australians. This study aimed to: explore the extent of variation in delivery of recommended STI screening investigations and counselling within Aboriginal primary health care (PHC) centres; identify the factors associated with variation in screening practices; and determine if provision of STI testing and counselling increased with participation in Continuous Quality Improvement (CQI).
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improving the provision of pregnancy care for aboriginal and torres strait islander women a Continuous Quality Improvement initiative
BMC Pregnancy and Childbirth, 2016Co-Authors: Melanie Gibsonhelm, Alice R Rumbold, Ross S Bailie, Helena J Teede, Sanjeeva Ranasinha, Jacqueline BoyleAbstract:Australian Aboriginal and Torres Strait Islander (Indigenous) women are at greater risk of adverse pregnancy outcomes than non-Indigenous women. Pregnancy care has a key role in identifying and addressing modifiable risk factors that contribute to adverse outcomes. We investigated whether participation in a Continuous Quality Improvement (CQI) initiative was associated with increases in provision of recommended pregnancy care by primary health care centers (PHCs) in predominantly Indigenous communities, and whether provision of care was associated with organizational systems or characteristics. Longitudinal analysis of 2220 pregnancy care records from 50 PHCs involved in up to four cycles of CQI in Australia between 2007 and 2012. Linear and logistic regression analyses investigated associations between documented provision of pregnancy care and each CQI cycle, and self-ratings of organizational systems. Main outcome measures included screening and counselling for lifestyle-related risk factors. Women attending PHCs after ≥1 CQI cycles were more likely to receive each pregnancy care measure than women attending before PHCs had completed one cycle e.g. screening for cigarette use: baseline = 73 % (reference), cycle one = 90 % [odds ratio (OR):3.0, 95 % confidence interval (CI):2.2-4.1], two = 91 % (OR:5.1, 95 % CI:3.3-7.8), three = 93 % (OR:6.3, 95 % CI:3.1-13), four = 95 % (OR:11, 95 % CI:4.3-29). Greater self-ratings of overall organizational systems were significantly associated with greater screening for alcohol use (β = 6.8, 95 % CI:0.25-13), nutrition counselling (β = 8.3, 95 % CI:3.1-13), and folate prescription (β = 7.9, 95 % CI:2.6-13). Participation in a CQI initiative by PHCs in Indigenous communities is associated with greater provision of pregnancy care regarding lifestyle-related risk factors. More broadly, these findings support incorporation of CQI activities addressing systems level issues into primary care settings to improve the Quality of pregnancy care.
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responses of aboriginal and torres strait islander primary health care services to Continuous Quality Improvement initiatives
Frontiers in Public Health, 2016Co-Authors: Veronica Matthews, Gill Schierhout, Sandra C Thompson, Sarah Larkins, Cindy Woods, Maxwell Mitropoulos, Tania Patrao, Annette Panzera, Ross S BailieAbstract:Background Indigenous Primary Health Care (PHC) services participating in Continuous Quality Improvement (CQI) cycles show varying patterns of performance over time. Understanding this variation is essential to scaling up and sustaining Quality Improvement initiatives. The aim of this study was to examine trends in Quality of care for services participating in the ABCD National Research Partnership and describe patterns of change over time; and examine health service characteristics associated with positive and negative trends in Quality of care. Setting and participants PHC services providing care for Indigenous people in urban, rural and remote northern Australia that had completed at least three annual audits for at least one aspect of care (n=73). Methods/Design Longitudinal clinical audit data from use of four clinical audit tools (maternal health, child health, preventive health, Type 2 diabetes) between 2005 and 2013 were analysed. Health centre performance was classified into six patterns of change over time: consistent high Improvement (positive), sustained high performance (positive), decline (negative), marked variability (negative), consistent low performance (negative), and no specific increase or decrease (neutral). Backwards stepwise multiple logistic regression analyses were used to examine the associations between health service characteristics and positive or negative trends in Quality of care. Results Trends in Quality of care varied widely between health services across the four audit tools. Regression analyses of health service characteristics revealed no consistent statistically significant associations of population size, remoteness, governance model or accreditation status with positive or negative trends in Quality of care. Conclusions The variable trends in Quality of care as reflected by CQI audit tools do not appear to be related to easily measurable health service characteristics. This points to the need for a deeper or more nuanced understanding of factors that moderate the effect of CQI on health service performance for the purpose of strengthening enablers and overcoming barriers to Improvement.
Michelle Dowden - One of the best experts on this subject based on the ideXlab platform.
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implementation of Continuous Quality Improvement in aboriginal and torres strait islander primary health care in australia a scoping systematic review
BMC Health Services Research, 2018Co-Authors: Karen Gardner, Michelle Dowden, Beverly Sibthorpe, Mier Chan, Ginny Sargent, Daniel McaullayAbstract:Continuous Quality Improvement (CQI) programs have been taken up widely by Indigenous primary health care (PHC) services in Australia and there has been national policy commitment to support this. However, international evidence shows that implementing CQI is challenging, impacts are variable and little is known about the factors that impede or enhance effectiveness. A scoping review was undertaken to explore uptake and implementation in Indigenous PHC, including barriers and enablers to embedding CQI in routine practice. We provide guidance on how research and evaluation might be intensified to support implementation. Searches were conducted in MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews. Key websites and publications were handsearched. Studies conducted in Indigenous PHC which demonstrated some combination of CQI characteristics and assessed some aspect of implementation were included. A two stage analysis was undertaken. Stage 1 identified the breadth and focus of literature. Stage 2 investigated barriers and enablers. The Framework for Performance Assessment in PHC (2008) was used to frame the analysis. Data were extracted on the study type, approach, timeframes, CQI strategies, barriers and enablers. Sixty articles were included in Stage 1 and 21 in Stage 2. Barriers to implementing CQI processes relate primarily to professional and organisational processes and operate at multiple levels (individual, team, service, health system) whereas barriers to improved care relate more directly to knowledge of best practice and team processes that facilitate appropriate care. Few studies described implementation timeframes, number of CQI cycles or Improvement strategies implemented and only two applied a change theory. Investigating barriers and enablers that modify implementation and impacts of CQI poses conceptual and methodological challenges. More complete description of CQI processes, implementation strategies, and barriers and enablers could enhance capacity for comparisons across settings and contribute to better understanding of key success factors.
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Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre based Continuous Quality Improvement approach
BMC Health Services Research, 2013Co-Authors: Anna P Ralph, Michelle Dowden, Marea Fittock, Rosalie Schultz, Dale Thompson, Tom Clemens, Matthew Parnaby, Michele Clark, Malcolm Mcdonald, Keith EdwardsAbstract:Background: Rheumatic heart disease (RHD) remains a major health concern for Aboriginal Australians. A key component of RHD control is prevention of recurrent acute rheumatic fever (ARF) using long-term secondary prophylaxis with intramuscular benzathine penicillin (BPG). This is the most important and cost-effective step in RHD control. However, there are significant challenges to effective implementation of secondary prophylaxis programs. This project aimed to increase understanding and improve Quality of RHD care through development and implementation of a Continuous Quality Improvement (CQI) strategy. Methods: We used a CQI strategy to promote implementation of national best-practice ARF/RHD management guidelines at primary health care level in Indigenous communities of the Northern Territory (NT), Australia, 2008–2010. Participatory action research methods were employed to identify system barriers to delivery of high Quality care. This entailed facilitated discussion with primary care staff aided by a system assessment tool (SAT). Participants were encouraged to develop and implement strategies to overcome identified barriers, including better record-keeping, triage systems and strategies for patient follow-up. To assess performance, clinical records were audited at baseline, then annually for two years. Key performance indicators included proportion of people receiving adequate secondary prophylaxis (≥80% of scheduled 4-weekly penicillin injections) and Quality of documentation. Results: Six health centres participated, servicing approximately 154 people with ARF/RHD. Improvements occurred in indicators of service delivery including proportion of people receiving ≥40% of their scheduled BPG (increasing from 81/116 [70%] at baseline to 84/103 [82%] in year three, p = 0.04), proportion of people reviewed by a doctor within the past two years (112/154 [73%] and 134/156 [86%], p =0.003), and proportion of people who received influenza vaccination (57/154 [37%] to 86/156 [55%], p =0.001). However, the proportion receiving ≥80% of scheduled BPG did not change. Documentation in medical files improved: ARF episode documentation increased from 31/55 (56%) to 50/62 (81%) (p= 0.004), and RHD risk category documentation from 87/154 (56%) to 103/145 (76%) (p<0.001). Large differences in performance were noted between health centres, reflected to some extent in SAT scores. Conclusions: A CQI process using a systems approach and participatory action research methodology can significantly improve delivery of ARF/RHD care.
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evaluating the effectiveness of a multifaceted multilevel Continuous Quality Improvement program in primary health care developing a realist theory of change
Implementation Science, 2013Co-Authors: Gillian Schierhout, Lynette R Odonoghue, Jennifer Hains, Catherine Kennedy, Rhonda Cox, Ru Kwedza, Marea Fittock, Jenny Brands, Katrina Lonergan, Michelle DowdenAbstract:Background: Variation in effectiveness of Continuous Quality Improvement (CQI) interventions between services is commonly reported, but with little explanation of how contextual and other factors may interact to produce this variation. Therefore, there is scant information available on which policy makers can draw to inform effective implementation in different settings. In this paper, we explore how patterns of change in delivery of services may have been achieved in a diverse range of health centers participating in a wide-scale program to achieve Improvements in Quality of care for Indigenous Australians. Methods: We elicited key informants’ interpretations of factors explaining patterns of change in delivery of guideline-scheduled services over three or more years of a wide-scale CQI project, and inductively analyzed these interpretations to propose fine-grained realist hypotheses about what works for whom and in what circumstances. Data were derived from annual clinical audits from 36 health centers operating in diverse settings, quarterly project monitoring reports, and workshops with 12 key informants who had key roles in project implementation. We
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indigenous health effective and sustainable health services through Continuous Quality Improvement
The Medical Journal of Australia, 2007Co-Authors: Ross Bailie, Lynette R Odonoghue, Michelle DowdenAbstract:force. 2 In addition to other experience and resources, the Healthy for Life program has drawn on the tools, processes and principles developed through an action–research project in the Northern Territory — the ABCD project. “ABCD” originally stood for Audit for Best practice in Chronic Disease. It has come to represent a structured collaborative approach to improving health services, with potential application in a variety of primary care contexts. The ABCD research project is a collaborative initiative of the Cooperative Research Centre for Aboriginal Health, initially funded by the Australian Health Ministers’ Advisory Council, which brought together federal, state and territory government health agencies; Indigenous community-controlled health organisations; and research agencies. The project commenced in 12 Indigenous community health centres in the Top End of the Northern Territory in 2003. Its commencement was independent of, but more or less in parallel with, various other initiatives contributing to the development of the Healthy for Life program. Here, we discuss some of the key strengths of the approach we have developed, and the evidence and values base for Continuous Quality Improvement (CQI) in this context.
Veronica Matthews - One of the best experts on this subject based on the ideXlab platform.
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syphilis testing performance in aboriginal primary health care exploring impact of Continuous Quality Improvement over time
Australian Journal of Primary Health, 2020Co-Authors: Armita Adily, Veronica Matthews, Seham Girgis, Catherine D Este, Jeanette E WardAbstract:Data from 110 primary healthcare clinics participating in two or more Continuous Quality Improvement (CQI) cycles in preventive care, which included syphilis testing performance (STP) for Aboriginal and Torres Strait Islander people aged between 15 and 54 years, were used to examine whether the number of audit cycles including syphilis testing was associated over time with STP Improvement at clinic level in this specific measure of public health importance. The number of cycles per clinic ranged from two to nine (mode 3). As shown by medical record audit at entry to CQI, only 42 (38%) clinics had tested or approached 50% or more of their eligible clients for syphilis in the prior 24 months. Using mixed effects logistic regression, it was found that the odds of a clinic's STP relative to its first cycle increased only modestly. Counterintuitively, clinics undertaking the most preventive health CQI cycles tended to have the lowest STP throughout. Participation in a general preventive care CQI tool was insufficient to achieve and sustain high rates of STP for Aboriginal and Torres Strait Islander people required for public health benefit. Improving STP requires dedicated effort and greater understanding of barriers to effective CQI within and beyond clinic control.
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an all teach all learn approach to research capacity strengthening in indigenous primary health care Continuous Quality Improvement
Frontiers in Public Health, 2018Co-Authors: Karen Mcphailbell, Veronica Matthews, Roxanne Bainbridge, Michelle Redmanmaclaren, Deborah A Askew, Shanthi Ramanathan, Jodie Bailie, Ross BailieAbstract:In Australia, Indigenous people experience poor access to healthcare and the highest rates of morbidity and mortality of any population group. Despite modest Improvements in recent years, concerns remains that Indigenous people have been over-researched without corresponding health Improvements. Embedding Indigenous leadership, participation and priorities in health research is an essential strategy for meaningful change for Indigenous people. To centralize Indigenous perspectives in research processes, a transformative shift away from traditional approaches that have benefited researchers and non-Indigenous agendas is required. This shift must involve concomitant strengthening of the research capacity of Indigenous and non-Indigenous researchers and research translators – all must teach and all must learn. However, there is limited evidence about how to strengthen systems and stakeholder capacity to participate in and lead CQI research in Indigenous primary healthcare, to the benefit of Indigenous people. This paper describes the collaborative development of, and principles underpinning a research capacity strengthening model in a national Indigenous primary healthcare Continuous Quality Improvement research network. The development process identified the need to address power imbalances, cultural contexts, relationships, systems requirements and existing knowledge, skills and experience of all parties. Taking a strengths-based perspective, we harnessed existing knowledge, skills and experiences; hence our emphasis on capacity ‘strengthening’. New insights are provided into the complex processes of research capacity strengthening within the context of Continuous Quality Improvement in Indigenous primary healthcare.
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impact of policy support on uptake of evidence based Continuous Quality Improvement activities and the Quality of care for indigenous australians a comparative case study
BMJ Open, 2017Co-Authors: Ross Bailie, Veronica Matthews, Jodie Bailie, Sandra C Thompson, Ru Kwedza, Sarah Larkins, Paul Burgess, Tarun Weeramanthri, Frances C Cunningham, Louise ClarkAbstract:Objectives To examine the impact of state/territory policy support on (1) uptake of evidence-based Continuous Quality Improvement (CQI) activities and (2) Quality of care for Indigenous Australians. Design Mixed-method comparative case study methodology, drawing on Quality-of-care audit data, documentary evidence of policies and strategies and the experience and insights of stakeholders involved in relevant CQI programmes. We use multilevel linear regression to analyse jurisdictional differences in Quality of care. Setting Indigenous primary healthcare services across five states/territories of Australia. Participants 175 Indigenous primary healthcare services. Interventions A range of national and state/territory policy and infrastructure initiatives to support CQI, including support for applied research. Primary and secondary outcome measures (i) Trends in the consistent uptake of evidence-based CQI tools available through a research-based CQI initiative (the Audit and Best Practice in Chronic Disease programme) and (ii) Quality of care (as reflected in adherence to best practice guidelines). Results Progressive uptake of evidence-based CQI activities and steady Improvements or maintenance of high-Quality care occurred where there was long-term policy and infrastructure support for CQI. Where support was provided but not sustained there was a rapid rise and subsequent fall in relevant CQI activities. Conclusions Health authorities should ensure consistent and sustained policy and infrastructure support for CQI to enable wide-scale and ongoing Improvement in Quality of care and, subsequently, health outcomes. It is not sufficient for Improvement initiatives to rely on local service managers and clinicians, as their efforts are strongly mediated by higher system-level influences.
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wide variation in sexually transmitted infection testing and counselling at aboriginal primary health care centres in australia analysis of longitudinal Continuous Quality Improvement data
BMC Infectious Diseases, 2017Co-Authors: Barbara Nattabi, Veronica Matthews, Jodie Bailie, Alice R Rumbold, David Scrimgeour, Gill Schierhout, James Ward, John M Kaldor, Sandra C Thompson, Ross S BailieAbstract:Background Chlamydia, gonorrhoea and syphilis are readily treatable sexually transmitted infections (STIs) which continue to occur at high rates in Australia, particularly among Aboriginal Australians. This study aimed to: explore the extent of variation in delivery of recommended STI screening investigations and counselling within Aboriginal primary health care (PHC) centres; identify the factors associated with variation in screening practices; and determine if provision of STI testing and counselling increased with participation in Continuous Quality Improvement (CQI).
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responses of aboriginal and torres strait islander primary health care services to Continuous Quality Improvement initiatives
Frontiers in Public Health, 2016Co-Authors: Veronica Matthews, Gill Schierhout, Sandra C Thompson, Sarah Larkins, Cindy Woods, Maxwell Mitropoulos, Tania Patrao, Annette Panzera, Ross S BailieAbstract:Background Indigenous Primary Health Care (PHC) services participating in Continuous Quality Improvement (CQI) cycles show varying patterns of performance over time. Understanding this variation is essential to scaling up and sustaining Quality Improvement initiatives. The aim of this study was to examine trends in Quality of care for services participating in the ABCD National Research Partnership and describe patterns of change over time; and examine health service characteristics associated with positive and negative trends in Quality of care. Setting and participants PHC services providing care for Indigenous people in urban, rural and remote northern Australia that had completed at least three annual audits for at least one aspect of care (n=73). Methods/Design Longitudinal clinical audit data from use of four clinical audit tools (maternal health, child health, preventive health, Type 2 diabetes) between 2005 and 2013 were analysed. Health centre performance was classified into six patterns of change over time: consistent high Improvement (positive), sustained high performance (positive), decline (negative), marked variability (negative), consistent low performance (negative), and no specific increase or decrease (neutral). Backwards stepwise multiple logistic regression analyses were used to examine the associations between health service characteristics and positive or negative trends in Quality of care. Results Trends in Quality of care varied widely between health services across the four audit tools. Regression analyses of health service characteristics revealed no consistent statistically significant associations of population size, remoteness, governance model or accreditation status with positive or negative trends in Quality of care. Conclusions The variable trends in Quality of care as reflected by CQI audit tools do not appear to be related to easily measurable health service characteristics. This points to the need for a deeper or more nuanced understanding of factors that moderate the effect of CQI on health service performance for the purpose of strengthening enablers and overcoming barriers to Improvement.
Jean Carlet - One of the best experts on this subject based on the ideXlab platform.
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a Continuous Quality Improvement program reduces nosocomial infection rates in the icu
Intensive Care Medicine, 2004Co-Authors: Benoit Misset, J F Timsit, Mariefrancoise Dumay, Maite Garrouste, Annie Chalfine, Isabelle Flouriot, F W Goldstein, Jean CarletAbstract:Objective To assess the impact of a Continuous Quality-Improvement program on nosocomial infection rates.
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a Continuous Quality Improvement program reduces nosocomial infection rates in the icu
Intensive Care Medicine, 2004Co-Authors: Benoit Misset, J F Timsit, Mariefrancoise Dumay, Maite Garrouste, Annie Chalfine, Isabelle Flouriot, F W Goldstein, Jean CarletAbstract:To assess the impact of a Continuous Quality-Improvement program on nosocomial infection rates. Prospective single-center study in the medical-surgical ICU of a tertiary care center. We admitted 1764 patients during the 5-year study period (1995–2000); 55% were mechanically ventilated and 21% died. Mean SAPS II was 37±21 points and mean length of ICU stay was 9.7±16.1 days. Implementation of an infection control program based on international recommendations. The program was updated regularly according to infection and colonization rates and reports in the literature. Prospective surveillance showed the following rates per 1000 procedure days: ventilator-associated pneumonia (VAP) 8.7, urinary tract infection (UTI) 17.2, central venous catheter (CVC) colonization 6.1, and CVC-related bacteremia and2.0; arterial catheter colonization did not occur. In the 5 years following implementation of the infection control program there was a significant decline in the rate per patient days of UTI, CVC colonization, and CVC-related bacteremia but not VAP. Between the first and second 2.5-year periods the time to infection increased significantly for UTI and CVC-related colonization. A Continuous Quality-Improvement program based on surveillance of nosocomial infections in a nonselected medical-surgical ICU population was associated with sustained decreases in UTI and CVC-related infections.
Sandra C Thompson - One of the best experts on this subject based on the ideXlab platform.
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impact of policy support on uptake of evidence based Continuous Quality Improvement activities and the Quality of care for indigenous australians a comparative case study
BMJ Open, 2017Co-Authors: Ross Bailie, Veronica Matthews, Jodie Bailie, Sandra C Thompson, Ru Kwedza, Sarah Larkins, Paul Burgess, Tarun Weeramanthri, Frances C Cunningham, Louise ClarkAbstract:Objectives To examine the impact of state/territory policy support on (1) uptake of evidence-based Continuous Quality Improvement (CQI) activities and (2) Quality of care for Indigenous Australians. Design Mixed-method comparative case study methodology, drawing on Quality-of-care audit data, documentary evidence of policies and strategies and the experience and insights of stakeholders involved in relevant CQI programmes. We use multilevel linear regression to analyse jurisdictional differences in Quality of care. Setting Indigenous primary healthcare services across five states/territories of Australia. Participants 175 Indigenous primary healthcare services. Interventions A range of national and state/territory policy and infrastructure initiatives to support CQI, including support for applied research. Primary and secondary outcome measures (i) Trends in the consistent uptake of evidence-based CQI tools available through a research-based CQI initiative (the Audit and Best Practice in Chronic Disease programme) and (ii) Quality of care (as reflected in adherence to best practice guidelines). Results Progressive uptake of evidence-based CQI activities and steady Improvements or maintenance of high-Quality care occurred where there was long-term policy and infrastructure support for CQI. Where support was provided but not sustained there was a rapid rise and subsequent fall in relevant CQI activities. Conclusions Health authorities should ensure consistent and sustained policy and infrastructure support for CQI to enable wide-scale and ongoing Improvement in Quality of care and, subsequently, health outcomes. It is not sufficient for Improvement initiatives to rely on local service managers and clinicians, as their efforts are strongly mediated by higher system-level influences.
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wide variation in sexually transmitted infection testing and counselling at aboriginal primary health care centres in australia analysis of longitudinal Continuous Quality Improvement data
BMC Infectious Diseases, 2017Co-Authors: Barbara Nattabi, Veronica Matthews, Jodie Bailie, Alice R Rumbold, David Scrimgeour, Gill Schierhout, James Ward, John M Kaldor, Sandra C Thompson, Ross S BailieAbstract:Background Chlamydia, gonorrhoea and syphilis are readily treatable sexually transmitted infections (STIs) which continue to occur at high rates in Australia, particularly among Aboriginal Australians. This study aimed to: explore the extent of variation in delivery of recommended STI screening investigations and counselling within Aboriginal primary health care (PHC) centres; identify the factors associated with variation in screening practices; and determine if provision of STI testing and counselling increased with participation in Continuous Quality Improvement (CQI).
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responses of aboriginal and torres strait islander primary health care services to Continuous Quality Improvement initiatives
Frontiers in Public Health, 2016Co-Authors: Veronica Matthews, Gill Schierhout, Sandra C Thompson, Sarah Larkins, Cindy Woods, Maxwell Mitropoulos, Tania Patrao, Annette Panzera, Ross S BailieAbstract:Background Indigenous Primary Health Care (PHC) services participating in Continuous Quality Improvement (CQI) cycles show varying patterns of performance over time. Understanding this variation is essential to scaling up and sustaining Quality Improvement initiatives. The aim of this study was to examine trends in Quality of care for services participating in the ABCD National Research Partnership and describe patterns of change over time; and examine health service characteristics associated with positive and negative trends in Quality of care. Setting and participants PHC services providing care for Indigenous people in urban, rural and remote northern Australia that had completed at least three annual audits for at least one aspect of care (n=73). Methods/Design Longitudinal clinical audit data from use of four clinical audit tools (maternal health, child health, preventive health, Type 2 diabetes) between 2005 and 2013 were analysed. Health centre performance was classified into six patterns of change over time: consistent high Improvement (positive), sustained high performance (positive), decline (negative), marked variability (negative), consistent low performance (negative), and no specific increase or decrease (neutral). Backwards stepwise multiple logistic regression analyses were used to examine the associations between health service characteristics and positive or negative trends in Quality of care. Results Trends in Quality of care varied widely between health services across the four audit tools. Regression analyses of health service characteristics revealed no consistent statistically significant associations of population size, remoteness, governance model or accreditation status with positive or negative trends in Quality of care. Conclusions The variable trends in Quality of care as reflected by CQI audit tools do not appear to be related to easily measurable health service characteristics. This points to the need for a deeper or more nuanced understanding of factors that moderate the effect of CQI on health service performance for the purpose of strengthening enablers and overcoming barriers to Improvement.
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duration of participation in Continuous Quality Improvement a key factor explaining improved delivery of type 2 diabetes services
BMC Health Services Research, 2014Co-Authors: Veronica Matthews, Sandra C Thompson, Gillian Schierhout, Catherine Kennedy, Ru Kwedza, Sarah Larkins, James Mcbroom, Christine Connors, Elizabeth Moore, David ScrimgeourAbstract:Background: It is generally recognised that Continuous Quality Improvement (CQI) programs support development of high Quality primary health care systems. However, there is limited evidence demonstrating their system-wide effectiveness. We examined variation in Quality of Type 2 diabetes service delivery in over 100 Aboriginal and Torres Strait Islander primary health care centres participating in a wide-scale CQI project over the past decade, and determined the influence of health centre and patient level factors on Quality of care, with specific attention to health centre duration of participation in a CQI program. Methods: We analysed over 10,000 clinical audit records to assess Quality of Type 2 diabetes care of patients in 132 Aboriginal and Torres Strait Islander community health centres in five states/territories participating in the ABCD project for varying periods between 2005 and 2012. Process indicators of Quality of care for each patient were calculated by determining the proportion of recommended guideline scheduled services that were documented as delivered. Multilevel regression models were used to quantify the amount of variation in Type 2 diabetes service delivery attributable to health centre or patient level factors and to identify those factors associated with greater adherence to best practice guidelines. Results: Health centre factors that were independently associated with adherence to best practice guidelines included longer participation in the CQI program, remoteness of health centres, and regularity of client attendance. Significantly associated patient level variables included greater age, and number of co-morbidities and disease complications. Health centre factors explained 37% of the differences in level of service delivery between jurisdictions with patient factors explaining only a further 1%. Conclusions: At the health centre level, Type 2 diabetes service delivery could be improved through long term commitment to CQI, encouraging regular attendance (for example, through patient reminder systems) and improved recording and coordination of patient care in the complex service provider environments that are characteristic of non-remote areas.
