Improving the provision of pregnancy care for Aboriginal and Torres Strait Islander women: a continuous quality improvement initiative.

Melanie E Gibson-Helm,Helena J Teede,Alice R Rumbold,Jacqueline A Boyle,Sanjeeva Ranasinha,Ross S Bailie

doi:10.1186/s12884-016-0892-1

Abstract

BackgroundAustralian Aboriginal and Torres Strait Islander (Indigenous) women are at greater risk of adverse pregnancy outcomes than non-Indigenous women. Pregnancy care has a key role in identifying and addressing modifiable risk factors that contribute to adverse outcomes. We investigated whether participation in a continuous quality improvement (CQI) initiative was associated with increases in provision of recommended pregnancy care by primary health care centers (PHCs) in predominantly Indigenous communities, and whether provision of care was associated with organizational systems or characteristics.MethodsLongitudinal analysis of 2220 pregnancy care records from 50 PHCs involved in up to four cycles of CQI in Australia between 2007 and 2012. Linear and logistic regression analyses investigated associations between documented provision of pregnancy care and each CQI cycle, and self-ratings of organizational systems. Main outcome measures included screening and counselling for lifestyle-related risk factors.ResultsWomen attending PHCs after ≥1 CQI cycles were more likely to receive each pregnancy care measure than women attending before PHCs had completed one cycle e.g. screening for cigarette use: baseline = 73 % (reference), cycle one = 90 % [odds ratio (OR):3.0, 95 % confidence interval (CI):2.2-4.1], two = 91 % (OR:5.1, 95 % CI:3.3-7.8), three = 93 % (OR:6.3, 95 % CI:3.1-13), four = 95 % (OR:11, 95 % CI:4.3-29). Greater self-ratings of overall organizational systems were significantly associated with greater screening for alcohol use (β = 6.8, 95 % CI:0.25-13), nutrition counselling (β = 8.3, 95 % CI:3.1-13), and folate prescription (β = 7.9, 95 % CI:2.6-13).ConclusionParticipation in a CQI initiative by PHCs in Indigenous communities is associated with greater provision of pregnancy care regarding lifestyle-related risk factors. More broadly, these findings support incorporation of CQI activities addressing systems level issues into primary care settings to improve the quality of pregnancy care.

Highlights

Australian Aboriginal and Torres Strait Islander (Indigenous) women are at greater risk of adverse pregnancy outcomes than non-Indigenous women
Pregnancy care is usually provided by primary health care centers (PHCs), with women transferring to regional hospitals for the birth
We investigated whether provision of care related to these risk factors increased after PHC participation in a large-scale continuous quality improvement (CQI) initiative implemented across multiple settings

Summary

Introduction

Australian Aboriginal and Torres Strait Islander (Indigenous) women are at greater risk of adverse pregnancy outcomes than non-Indigenous women. Preterm birth, perinatal death and neural tube defects are more common in babies of Indigenous women [1,2,3] and lifestyle-related risk factors such as smoking, alcohol use, low peri-conception folate use and poor nutrition are more common among Indigenous women [2,3,4,5,6]. The type of pregnancy care available in Australia often depends on service availability, the woman’s preferences and her risk profile [8] It can consist of primary and/or hospital care and often involves a range of health professionals [8]. PHCs can either be governed by the jurisdiction’s government or be one of over 150 community-controlled health services initiated and operated by the local Indigenous community to deliver holistic, comprehensive, and culturally appropriate health care [10]

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Conclusion