Prevention and management of chronic disease in Aboriginal and Islander Community Controlled Health Services in Queensland: a quality improvement study assessing change in selected clinical performance indicators over time in a cohort of services

Abstract

ObjectiveTo evaluate clinical healthcare performance in Aboriginal Medical Services in Queensland and to consider future directions in supporting improvement through measurement, target setting and standards development.DesignLongitudinal study assessing baseline performance and improvements in service delivery, clinical care and selected outcomes against key performance indicators 2009–2010.Setting27 Aboriginal and Islander Community Controlled Health Services (AICCHSs) in Queensland, who are members of the Queensland Aboriginal and Islander Health Council (QAIHC).Participants22 AICCHS with medical clinics.InterventionImplementation and use of an electronic clinical information system that integrates with electronic health records supported by the QAIHC quality improvement programme—the Close the Gap Collaborative.Main outcome measuresProportion of patients with current recording of key healthcare activities and the prevalence of risk factors and chronic disease.ResultsAggregated performance was high on a number of key risk factors and healthcare activities including assessment of tobacco use and management of hypertension but low for others. Performance between services showed greatest variation for care planning and health check activity.ConclusionsData collected by the QAIHC health information system highlight the risk factor workload facing the AICCHS in Queensland, demonstrating the need for ongoing support and workforce planning. Development of targets and weighting models is necessary to enable robust between-service comparisons of performance, which has implications for health reform initiatives in Australia. The limited information available suggests that although performance on key activities in the AICCHS sector has potential for improvement in some areas, it is nonetheless at a higher level than for mainstream providers.ImplicationsThe work demonstrates the role that the Community Controlled sector can play in closing the gap in Aboriginal and Torres Strait Islander health outcomes by leading the use of clinical data to record and assess the quality of services and health outcome.

Sustained participation in annual continuous quality improvement activities improves quality of care for Aboriginal and Torres Strait Islander children

“…However, the published literature on its effectiveness remains quite limited. We located 14 publications reporting on client care, of which only 6 reported on client outcomes in the last 15 years . Only three of these examined impacts across consecutive audits and none reported on child health outcomes.…”

Are general practitioners getting the information they need from hospitals and specialists to provide quality cancer care for Indigenous Australians?

“…[28][29][30] As a higher proportion of Indigenous Australians live in rural areas, 20 together with other Australians they have worse cancer outcomes than those living in major cities. [35][36][37] ACCHO offer welcoming social spaces, culturally safe care that is responsive to holistic needs, 38 and many Indigenous Australians value their accessibility. However, GP involvement in cancer care is varied, with GP based in rural areas having a greater role in cancer care than their major city counterparts.…”

“…[31][32][33] In Australia, community-based PHC services play an important role in prevention and management of disease in general. 36 From an international perspective, the services provided to Indigenous Australians with cancer form a useful case study. 34 In an effort to close the health disparities gap between Indigenous and non-Indigenous Australians, community controlled PHC services (referred to as Aboriginal Community Controlled Health Organisations (ACCHO)) exist in many parts of Australia (e.g.…”

Furthering the quality agenda in Aboriginal community controlled health services: understanding the relationship between accreditation, continuous quality improvement and national key performance indicator reporting

“…1). In partnership with the Improvement Foundation and general practice, QAIHC implemented the QAIHC CtG Collaborative (Panaretto et al 2013). Unlike the measures for One21seventy and the APCC CtG Collaborative, QAIHC developed a smaller, more focused set of measures in priority areas (called the 'QAIHC core indicators') that are also in the nKPIs.…”