Variation in quality of preventive care for well adults in Indigenous community health centres in Australia

Bailie, Ross; Si, Damin; Connors, Christine; Kwedza, Ru; O'Donoghue, Lynette R.; Kennedy, Catherine; Cox, Rhonda; Liddle, Helen E.; Hains, Jenny; Dowden, Michelle; Burke, Hugh; Brown, Alex; Weeramanthri, Tarun; Thompson, Sandra C.

doi:10.1186/1472-6963-11-139

Cited by 29 publications

(51 citation statements)

References 14 publications

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“…Quantitative methods to examine variation on these measures across the project have been previously reported [7,8]. From the diverse range of patterns of change in the clinical audit data for each health center over the duration of the study, we identified a number of major qualitative patterns of change (along the lines of the data presented in Figure 2).…”

Section: Methodsmentioning

confidence: 99%

Evaluating the effectiveness of a multifaceted, multilevel continuous quality improvement program in primary health care: developing a realist theory of change

Schierhout

Hains

et al. 2013

Implementation Sci

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BackgroundVariation 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.MethodsWe 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 abstracted potential context-mechanism-outcome configurations from the data, and based on these, identified potential program-strengthening strategies.ResultsSeveral context-specific, mechanism-based explanations for effectiveness of this CQI project were identified. These were collective valuing of clinical data for improvement purposes; collective efficacy; and organizational change towards a population health orientation. Health centers with strong central management of CQI, and those in which CQI efforts were more dependent on local health center initiative and were adapted to resonate with local priorities were both favorable contexts for collective valuing of clinical data. Where health centers had prior positive experiences of collaboration, effects appeared to be achieved at least partly through the mechanism of collective efficacy. Strong community linkages, staff ability to identify with patients, and staff having the skills and support to take broad ranging action, were favorable contexts for the mechanism of increased population health orientation.ConclusionsOur study provides evidence to support strategies for program strengthening described in the literature, and extends the understanding of mechanisms through which strategies may be effective in achieving particular outcomes in different contexts.

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Section: Methodsmentioning

confidence: 99%

Evaluating the effectiveness of a multifaceted, multilevel continuous quality improvement program in primary health care: developing a realist theory of change

Schierhout

Hains

et al. 2013

Implementation Sci

Self Cite

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“…In this setting, staff turnover is high and the burden of chronic disease, other infectious diseases, and child and maternal health needs is particularly high [17,18]. Given that resources are finite, particularly in regard to the availability of clinical personnel, several approaches have been used to support specialised areas of health service need in remote communities.…”

Section: Introductionmentioning

confidence: 99%

STI in remote communities: improved and enhanced primary health care (STRIVE) study protocol: a cluster randomised controlled trial comparing ‘usual practice’ STI care to enhanced care in remote primary health care services in Australia

et al. 2013

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BackgroundDespite two decades of interventions, rates of sexually transmissible infections (STI) in remote Australian Aboriginal communities remain unacceptably high. Routine notifications data from 2011 indicate rates of chlamydia and gonorrhoea among Aboriginal people in remote settings were 8 and 61 times higher respectively than in the non-Indigenous population.Methods/designSTRIVE is a stepped-wedge cluster randomised trial designed to compare a sexual health quality improvement program (SHQIP) to usual STI clinical care delivered in remote primary health care services. The SHQIP is a multifaceted intervention comprising annual assessments of sexual health service delivery, implementation of a sexual health action plan, six-monthly clinical service activity data reports, regular feedback meetings with a regional coordinator, training and financial incentive payments. The trial clusters comprise either a single community or several communities grouped together based on geographic proximity and cultural ties. The primary outcomes are: prevalence of chlamydia, gonorrhoea and trichomonas in Aboriginal residents aged 16–34 years, and performance in clinical management of STIs based on best practice indicators. STRIVE will be conducted over five years comprising one and a half years of trial initiation and community consultation, three years of trial conditions, and a half year of data analysis. The trial was initiated in 68 remote Aboriginal health services in the Northern Territory, Queensland and Western Australia.DiscussionSTRIVE is the first cluster randomised trial in STI care in remote Aboriginal health services. The trial will provide evidence to inform future culturally appropriate STI clinical care and control strategies in communities with high STI rates.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12610000358044

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“…While some centers provided excellent levels of assessments, others provided low levels. This variation in performance presents an opportunity for improvement in the documented delivery of these assessments by examining the factors that underlie variation in delivering services, as has previously been conducted in Aboriginal and Torres Strait Islander communities for preventative and diabetes care (22, 23). The successful strategies of the better-performing health centers could then be shared with the under-performing, to inform and support focused improvements in key areas of need.…”

Section: Discussionmentioning

confidence: 99%

Delivery of Eye and Vision Services in Aboriginal and Torres Strait Islander Primary Healthcare Centers

Burnett

Morse

Naduvilath

et al. 2016

Front. Public Health

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BackgroundRoutine eye and vision assessments are vital for the detection and subsequent management of vision loss, which is particularly important for Aboriginal and Torres Strait Islander people who face higher rates of vision loss than other Australians. In order to guide improvements, this paper will describe patterns, variations, and gaps in these eye and vision assessments for Aboriginal and Torres Strait Islander people.MethodsClinical audits from 124 primary healthcare centers (sample size 15,175) from five Australian states and territories were conducted during 2005–2012. Main outcome measure was adherence to current guidelines for delivery of eye and vision assessments to adults with diabetes, those without a diagnosed major chronic disease and children attending primary healthcare centers.ResultsOverall delivery of recommended eye and vision assessments varied widely between health centers. Of the adults with diabetes, 46% had a visual acuity assessment recorded within the previous 12 months (health center range 0–88%) and 33% had a retinal examination recorded (health center range 0–73%). Of the adults with no diagnosed major chronic disease, 31% had a visual acuity assessment recorded within the previous 2 years (health center range 0–86%) and 13% had received an examination for trichiasis (health center range 0–40%). In children, 49% had a record of a vision assessment (health center range 0–97%) and 25% had a record of an examination for trachoma within the previous 12 months (health center range 0–100%).ConclusionThere was considerable range and variation in the recorded delivery of scheduled eye and vision assessments across health centers. Sharing the successful strategies of the better-performing health centers to support focused improvements in key areas of need may increase overall rates of eye examinations, which is important for the timely detection, referral, and treatment of eye conditions affecting Aboriginal and Torres Strait Islander people, especially for those with diabetes.

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Variation in quality of preventive care for well adults in Indigenous community health centres in Australia

Cited by 29 publications

References 14 publications

Evaluating the effectiveness of a multifaceted, multilevel continuous quality improvement program in primary health care: developing a realist theory of change

Evaluating the effectiveness of a multifaceted, multilevel continuous quality improvement program in primary health care: developing a realist theory of change

STI in remote communities: improved and enhanced primary health care (STRIVE) study protocol: a cluster randomised controlled trial comparing ‘usual practice’ STI care to enhanced care in remote primary health care services in Australia

Delivery of Eye and Vision Services in Aboriginal and Torres Strait Islander Primary Healthcare Centers

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