Study protocol: primary healthcare transformation through patient-centred medical homes-improving access, relational care and outcomes in an urban Aboriginal and Torres Strait Islander population, a mixed methods prospective cohort study

Abstract

Introduction: For over 40 years, Aboriginal and Torres Strait Islander Community-Controlled Health Services (ACCHS) in Australia have led strategic responses to address the specific needs of Aboriginal and Torres Strait Islander populations. Globally, there has been rapid growth in urban Indigenous populations requiring an adaptive primary healthcare response. Patient-centred medical homes (PCMH) are an evidenced-based model of primary healthcare suited to this challenge, underpinned by principles aligned with the ACCHS sector-relational care responsive to patient identified healthcare priorities. Evidence is lacking on the implementation and effectiveness of the PCMH model of care governed by, and delivered for, Aboriginal and Torres Strait Islander populations in large urban settings.

Method and analysis: Our multiphased mixed-methods prospective cohort study will compare standard care provided by a network of ACCHS to an adapted PCMH model of care. Phase 1 using qualitative interviews with staff and patients and quantitative analysis of routine primary care health record data will examine the implementation, feasibility and acceptability of the PCMH. Phase 2 using linked survey, primary care and hospitalisation data will examine the impact of our adapted PCMH on access to care, relational and quality of care, health and wellbeing outcomes and economic costs. Phase 3 will synthesise evidence on mechanisms for change and discuss their implications for sustainability and transferability of PCMHs to the broader primary healthcare system ETHICS AND DISSEMINATION: This study has received approval from the University of Queensland Human Research Ethics Committee (2021/HE00529). This research represents an Aboriginal led and governed partnership in response to identified community priorities. The findings will contribute new knowledge on how key mechanisms underpinning the success and implementation of the model can be introduced into policy and practice. Study findings will be disseminated to service providers, researchers, policymakers and, most importantly, the communities themselves.

Keywords: EPIDEMIOLOGY; PRIMARY CARE; PUBLIC HEALTH; QUALITATIVE RESEARCH; Quality in health care.

Figure 1

A) Standard care pathway compared with B) ISoC2 model of care. GP, general practitioner; ISoC2, IUIH System of Care 2.

Figure 2

Timeline for research programme across intervention sites. EHR; electronic health records; FU, follow-up. Collection of interview and baseline survey data from intervention site 1 was completed by end of June 2020, as a pilot study with separate ethics approval. Collection of interview and baseline survey data from intervention site 2 and EHR data from all sites (intervention and standard care) was planned to begin June 2020. However, given the subsequent disruption to services and research activities due to the COVID-19 pandemic, actual data collection was deferred until mid-2021, with further delays due to later COVID-19 infection waves. EHR extraction in 2022 under the ISoC2 study from all sites covering period from 1 January 2016 – 31 December 2022; up to 2 years prior to implementation of site 1 accounting for disruption of services in 2018 due to a fire on the clinic premises in December 2017. Subsequent EHR update planned at approximately 12 month intervals. Survey participants will be invited to complete a follow-up survey approximately 3 years post the baseline survey. Linked hospital and emergency department data will be received in two files; first in 2023 and then a subsequent update in 2025.