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      Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples

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          Abstract

          Background

          Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE) project has facilitated the implementation of modern Continuous Quality Improvement (CQI) approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes. It has also highlighted substantial variation in quality of care. Through a partnership between academic researchers, service providers and policy makers, we are now implementing a study which aims to 1) explore the factors associated with variation in clinical performance; 2) examine specific strategies that have been effective in improving primary care clinical performance; and 3) work with health service staff, management and policy makers to enhance the effective implementation of successful strategies.

          Methods/Design

          The study will be conducted in Indigenous community health centres from at least six States/Territories (Northern Territory, Western Australia, New South Wales, South Australia, Queensland and Victoria) over a five year period. A research hub will be established in each region to support collection and reporting of quantitative and qualitative clinical and health centre system performance data, to investigate factors affecting variation in quality of care and to facilitate effective translation of research evidence into policy and practice. The project is supported by a web-based information system, providing automated analysis and reporting of clinical care performance to health centre staff and management.

          Discussion

          By linking researchers directly to users of research (service providers, managers and policy makers), the partnership is well placed to generate new knowledge on effective strategies for improving the quality of primary health care and fostering effective and efficient exchange and use of data and information among service providers and policy makers to achieve evidence-based resource allocation, service planning, system development, and improvements of service delivery and Indigenous health outcomes.

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          Most cited references22

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          Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement.

          To describe initial testing of the Assessment of Chronic Illness Care (ACIC), a practical quality-improvement tool to help organizations evaluate the strengths and weaknesses of their delivery of care for chronic illness in six areas: community linkages, self-management support, decision support, delivery system design, information systems, and organization of care. (1) Pre-post, self-report ACIC data from organizational teams enrolled in 13-month quality-improvement collaboratives focused on care for chronic illness; (2) independent faculty ratings of team progress at the end of collaborative. Teams completed the ACIC at the beginning and end of the collaborative using a consensus format that produced average ratings of their system's approach to delivering care for the targeted chronic condition. Average ACIC subscale scores (ranging from 0 to 11, with 11 representing optimal care) for teams across all four collaboratives were obtained to indicate how teams rated their care for chronic illness before beginning improvement work. Paired t-tests were used to evaluate the sensitivity. of the ACIC to detect system improvements for teams in two (of four) collaboratives focused on care for diabetes and congestive heart failure (CHF). Pearson correlations between the ACIC subscale scores and a faculty rating of team performance were also obtained. Average baseline scores across all teams enrolled at the beginning of the collaboratives ranged from 4.36 (information systems) to 6.42 (organization of care), indicating basic to good care for chronic illness. All six ACIC subscale scores were responsive to system improvements diabetes and CHF teams made over the course of the collaboratives. The most substantial improvements were seen in decision support, delivery system design, and information systems. CHF teams had particularly high scores in self-management support at the completion of the collaborative. Pearson correlations between the ACIC subscales and the faculty rating ranged from .28 to .52. These results and feedback from teams suggest that the ACIC is responsive to health care quality-improvement efforts and may be a useful tool to guide quality improvement in chronic illness care and to track progress over time.
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            Organizational interventions to implement improvements in patient care: a structured review of reviews

            Background Changing the organization of patient care should contribute to improved patient outcomes as functioning of clinical teams and organizational structures are important enablers for improvement. Objective To provide an overview of the research evidence on effects of organizational strategies to implement improvements in patient care. Design Structured review of published reviews of rigorous evaluations. Data sources Published reviews of studies on organizational interventions. Review methods Searches were conducted in two data-bases (Pubmed, Cochrane Library) and in selected journals. Reviews were included, if these were based on a systematic search, focused on rigorous evaluations of organizational changes, and were published between 1995 and 2003. Two investigators independently extracted information from the reviews regarding their clinical focus, methodological quality and main quantitative findings. Results A total of 36 reviews were included, but not all were high-quality reviews. The reviews were too heterogeneous for quantitative synthesis. None of the strategies produced consistent effects. Professional performance was generally improved by revision of professional roles and computer systems for knowledge management. Patient outcomes was generally improved by multidisciplinary teams, integrated care services, and computer systems. Cost savings were reported from integrated care services. The benefits of quality management remained uncertain. Conclusion There is a growing evidence base of rigorous evaluations of organizational strategies, but the evidence underlying some strategies is limited and for no strategy can the effects be predicted with high certainty.
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              Indigenous health: effective and sustainable health services through continuous quality improvement.

              The Australian government's Healthy for Life program is supporting capacity development in Indigenous primary care using continuous quality improvement (CQI) techniques. An important influence on the Healthy for Life program has been the ABCD research project. The key features contributing to the success of the project are described. The ABCD research project: uses a CQI approach, with an ongoing cycle of gathering data on how well organisational systems are functioning, and developing and then implementing improvements; is guided by widely accepted principles of community-based research, which emphasise participation; and adheres to the principles and values of Indigenous health research and service delivery. The potential for improving health outcomes in Aboriginal and Torres Strait Islander communities using a CQI approach should be strengthened by clear clinical and managerial leadership, supporting service organisations at the community level, and applying participatory-action principles.
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                Author and article information

                Journal
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central
                1472-6963
                2010
                19 May 2010
                : 10
                : 129
                Affiliations
                [1 ]Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia
                [2 ]Centre for Chronic Disease, School of Medicine, University of Queensland, Brisbane, Australia
                [3 ]Centre for Indigenous Health, University of Queensland, Brisbane, Australia
                [4 ]Centre for Population Health Research, Curtin Health Innovation Research Institute (CHIRI), Curtin University of Technology, Perth, Australia
                [5 ]Centre for Health and Society, School of Population Health, University of Melbourne, Melbourne, Australia
                [6 ]Discipline of Public Health, University of Adelaide, Adelaide, Australia
                [7 ]Aboriginal Health Council of South Australia, Adelaide, Australia
                [8 ]Northern Territory Department of Health and Families, Darwin, Australia
                [9 ]Western Australia Department of Health, Perth, Australia
                [10 ]Centre for International Health, Curtin University of Technology, Perth, Australia
                [11 ]Combined Universities Centre for Rural Health, University of Western Australia, Geraldton, Australia
                [12 ]Division of Health Sciences, University of South Australia, Adelaide, Australia
                [13 ]Maari Ma Health Aboriginal Corporation, Broken Hill, Australia
                [14 ]Aboriginal Medical Services Alliance Northern Territory, Darwin, Australia
                [15 ]Queensland Aboriginal and Torres Strait Islander Health Council, Brisbane, Australia
                [16 ]Aboriginal and Torres Strait Islander Community Health Service - Brisbane Ltd, Brisbane, Australia
                [17 ]Department of Health, Queensland Government, Brisbane, Australia
                [18 ]Department of Health, South Australian Government, Adelaide, Australia
                [19 ]Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia
                Article
                1472-6963-10-129
                10.1186/1472-6963-10-129
                2882384
                20482810
                6ad062b5-59ba-4943-a5c5-489bc69b4eb7
                Copyright ©2010 Bailie et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 April 2010
                : 19 May 2010
                Categories
                Study protocol

                Health & Social care
                Health & Social care

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