Duration of participation in continuous quality improvement: a key factor explaining improved delivery of Type 2 diabetes services

Abstract

BackgroundIt 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.MethodsWe 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.ResultsHealth 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%.ConclusionsAt 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.

Qualitative Evaluation of a Complex Intervention to Improve Rheumatic Heart Disease Secondary Prophylaxis

“…First, that CQI interventions need to be implemented for an adequate duration to effect change in primary care settings is shown here, supported by other recent studies applying CQI processes 19, 24. Second, this evaluation illustrates the critical importance of cultural competence within health systems, especially when tackling diseases of disparity such as RHD, which predominantly affects Indigenous and disadvantaged populations globally.…”

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

“…In addition, as data are collected from client records, service delivery may be underestimated due to poor documentation. We are also aware that services who have participated in three or more consecutive annual audits are possibly more committed to reviewing the quality of the care they deliver than those that did not participate and therefore may be generally better performing …”

“…We are also aware that services who have participated in three or more consecutive annual audits are possibly more committed to reviewing the quality of the care they deliver than those that did not participate and therefore may be generally better performing. 13 Does involvement in regular CQI activities lead to better services or do better services participate in regular CQI activities? These questions are for further investigation in our child health data.…”

“…However, the published literature on its effectiveness remains quite limited. We located 14 publications reporting on client care, [12][13][14][15][16][17][18][19][20][21][22][23][24][25] of which only 6 reported on client outcomes in the last 15 years. 14,15,18,19,21,22 Only three of these examined impacts across consecutive audits 14,22,23 and none reported on child health outcomes.…”

Exploring Systems That Support Good Clinical Care in Indigenous Primary Health-care Services: A Retrospective Analysis of Longitudinal Systems Assessment Tool Data from High-Improving Services

“…Continuous Quality Improvement (CQI) aims to facilitate ongoing improvement in the quality of primary care by using objective information to analyze and improve systems, processes, and outcomes (6). The evidence for the effectiveness of CQI is mixed and context dependent (7, 8); however, studies have shown that in some settings, it can be effective in improving quality of care (9), professional practice (10), and patient outcomes (11), particularly when used over longer periods of time (12). …”