Abstract
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. 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). 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. 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. 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.
Highlights
In Australia, there are disparities in health outcomes, with lower life expectancy and high rates of morbidity among Aboriginal and Torres Strait Islander populations and rural and remote populations [1]
Out of the 165 services participating in the ABCD National Research Partnership, 73 (44%) had completed three audits in at least one audit tool (61 for Type 2 diabetes audit, 65 for preventive audit, 42 for maternal audit, and 47 for child audit; Figure 1)
Forty of the 73 services are located in Queensland, 25 in the Northern Territory, 4 in New South Wales, 3 in Western Australia, and 1 in South Australia; 62 services are in remote locations, with the remainder in urban (n = 1) or inner or outer regional (n = 10) locations
Summary
In Australia, there are disparities in health outcomes, with lower life expectancy and high rates of morbidity among Aboriginal and Torres Strait Islander populations and rural and remote populations [1]. In rural and remote settings, characterized by geographic dispersion and workforce shortages, PHC can be delivered by a range of health-care providers, including resident general practitioners, remote area nurses, Indigenous Health Workers, and fly-in, fly-out services among others. In this context, improving the quality and consistency of PHC provided to Aboriginal and Torres Strait Islander people is an essential part of the Australian Government’s Close the Gap program [2]. Indigenous primary health-care (PHC) services participating in continuous quality improvement (CQI) cycles show varying patterns of performance over time. 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.
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