Duration of participation in continuous quality improvement: a key factor explaining improved delivery of Type 2 diabetes services

Veronica Matthews,Christine Connors,Gill Schierhout,Ross Bailie,David Scrimgeour,Elizabeth Moore,Catherine Kennedy,Sarah Larkins,James Mcbroom,Sandra Thompson,Ru Kwedza

doi:10.1186/s12913-014-0578-1

Abstract

BackgroundIt is generally recognised that continuous quality improvement (CQI) programs support development of high quality primary health care systems. However, there is limited evidence demonstrating their system-wide effectiveness. We examined variation in quality of Type 2 diabetes service delivery in over 100 Aboriginal and Torres Strait Islander primary health care centres participating in a wide-scale CQI project over the past decade, and determined the influence of health centre and patient level factors on quality of care, with specific attention to health centre duration of participation in a CQI program.MethodsWe analysed over 10,000 clinical audit records to assess quality of Type 2 diabetes care of patients in 132 Aboriginal and Torres Strait Islander community health centres in five states/territories participating in the ABCD project for varying periods between 2005 and 2012. Process indicators of quality of care for each patient were calculated by determining the proportion of recommended guideline scheduled services that were documented as delivered. Multilevel regression models were used to quantify the amount of variation in Type 2 diabetes service delivery attributable to health centre or patient level factors and to identify those factors associated with greater adherence to best practice guidelines.ResultsHealth centre factors that were independently associated with adherence to best practice guidelines included longer participation in the CQI program, remoteness of health centres, and regularity of client attendance. Significantly associated patient level variables included greater age, and number of co-morbidities and disease complications. Health centre factors explained 37% of the differences in level of service delivery between jurisdictions with patient factors explaining only a further 1%.ConclusionsAt the health centre level, Type 2 diabetes service delivery could be improved through long term commitment to CQI, encouraging regular attendance (for example, through patient reminder systems) and improved recording and coordination of patient care in the complex service provider environments that are characteristic of non-remote areas.

Highlights

It is generally recognised that continuous quality improvement (CQI) programs support development of high quality primary health care systems
There has been a significant increase in prevalence of diabetes in the Aboriginal and Torres Strait Islander population and they are three times more likely to have diabetes compared to the non-Indigenous Australian population [5]
The aim of this study is to examine trends in the quality of Type 2 diabetes processes of care over time for participating health centres and identify the influence of regional, health centre, and individual patient level factors on delivery of services scheduled in current guidelines

Summary

Introduction

It is generally recognised that continuous quality improvement (CQI) programs support development of high quality primary health care systems. We examined variation in quality of Type 2 diabetes service delivery in over 100 Aboriginal and Torres Strait Islander primary health care centres participating in a wide-scale CQI project over the past decade, and determined the influence of health centre and patient level factors on quality of care, with specific attention to health centre duration of participation in a CQI program. Social determinants and lack of access to quality primary health care (PHC) services are important contributors to the inequity in health outcomes between Aboriginal and Torres Strait Islander communities and the Australian non-Indigenous population. Evidence indicates that improvements in quality of care and health outcomes can be achieved using integrated care frameworks and multifaceted improvement strategies targeting changes at all levels of the health system [6,7,8,9]. The effectiveness of local and large scale quality improvement approaches in health care remains uncertain with published studies showing considerable variation in levels of improvements achieved [10,11]

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