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

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.

Figure 1

Outline of the ABCD approach.

Figure 2

Overall delivery of diabetes services by health centre (includes data for participating service up to 2008). The overall adherence to delivery of scheduled services for each patient was calculated by dividing the sum of services delivered by the total number of scheduled services and expressing this as a percentage. Each bar in the chart represents the average for overall delivery of scheduled services for clients in each health centre participating in the project. The highlighted bar shows the average for all health centres.

Figure 3

ABCD sites and associated Healthy for Life sites using the ABCD tools (December 2009).

Figure 4

Project management structure.