Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jan 21:3:288.
doi: 10.3389/fpubh.2015.00288. eCollection 2015.

Responses of Aboriginal and Torres Strait Islander Primary Health-Care Services to Continuous Quality Improvement Initiatives

Sarah Larkins  1 , Cindy E Woods  2 , Veronica Matthews  3 , Sandra C Thompson  4 , Gill Schierhout  3 , Maxwell Mitropoulos  5 , Tania Patrao  3 , Annette Panzera  2 , Ross Stewart Bailie  3
Affiliations

Responses of Aboriginal and Torres Strait Islander Primary Health-Care Services to Continuous Quality Improvement Initiatives

Sarah Larkins et al. Front Public Health. .

Abstract

Background: Indigenous primary health-care (PHC) services participating in continuous quality improvement (CQI) cycles show varying patterns of performance over time. Understanding this variation is essential to scaling up and sustaining quality improvement initiatives. The aim of this study is to examine trends in quality of care for services participating in the ABCD National Research Partnership and describe patterns of change over time and examine health service characteristics associated with positive and negative trends in quality of care.

Setting and participants: PHC services providing care for Indigenous people in urban, rural, and remote northern Australia that had completed at least three annual audits of service delivery for at least one aspect of care (n = 73).

Methods/design: Longitudinal clinical audit data from use of four clinical audit tools (maternal health, child health, preventive health, Type 2 diabetes) between 2005 and 2013 were analyzed. Health center performance was classified into six patterns of change over time: consistent high improvement (positive), sustained high performance (positive), decline (negative), marked variability (negative), consistent low performance (negative), and no specific increase or decrease (neutral). Backwards stepwise multiple logistic regression analyses were used to examine the associations between health service characteristics and positive or negative trends in quality of care.

Results: Trends in quality of care varied widely between health services across the four audit tools. Regression analyses of health service characteristics revealed no consistent statistically significant associations of population size, remoteness, governance model, or accreditation status with positive or negative trends in quality of care.

Conclusion: The variable trends in quality of care as reflected by CQI audit tools do not appear to be related to easily measurable health service characteristics. This points to the need for a deeper or more nuanced understanding of factors that moderate the effect of CQI on health service performance for the purpose of strengthening enablers and overcoming barriers to improvement.

Keywords: Aboriginal; Australia; Indigenous health services; Torres Strait Islander; best practice; primary health care; quality improvement; quality of care.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Health center performance flow diagram.
Figure 2
Figure 2
Examples of six patterns of performance categories.
See this image and copyright information in PMC

References

    1. Australian Institute of Health & Welfare; Rural, Regional and Remote Health: Indicators of Health System Performance. Canberra, ACT: AIHW; (2008).
    1. Council of Australian Governments; National Indigenous Reform Agreement (Closing the Gap). Canberra, ACT: Australian Government; (2012).
    1. Bailie R, Si D, Shannon C, Semmens J, Rowley K, Scrimgeour DJ, et al. Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples. BMC Health Serv Res (2010) 10:129–39.10.1186/1472-6963-10-129 - DOI - PMC - PubMed
    1. Si D, Bailie R, Dowden M, Kennedy C, Cox R, O’Donoghue L, et al. Assessing quality of diabetes care and its variation in Aboriginal community health centres in Australia. Diabetes Metab Res Rev (2010) 26:464–73.10.1002/dmrr.1062 - DOI - PubMed
    1. Graham N. Quality in Health Care: Theory, Application and Evolution. Gaithersburg, MD: Aspen Publishers; (1995).

LinkOut - more resources