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

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• 作者：Veronica Matthews (1)
  Gill Schierhout (1)
  James McBroom (2)
  Christine Connors (3)
  Catherine Kennedy (4)
  Ru Kwedza (5)
  Sarah Larkins (6)
  Elizabeth Moore (7)
  Sandra Thompson (8)
  David Scrimgeour (9)
  Ross Bailie (1)
  
  1. Menzies School of Health Research ; Brisbane ; Queensland ; Australia
  2. School of Environment ; Griffith University ; Brisbane ; Queensland ; Australia
  3. Department of Health ; Darwin ; Northern Territory ; Australia
  4. Maari Ma Health Aboriginal Corporation ; Broken Hill ; Far West New South Wales ; Australia
  5. Queensland Health ; Cairns ; Queensland ; Australia
  6. School of Medicine & Dentistry ; James Cook University ; Townsville ; Queensland ; Australia
  7. Aboriginal Medical Services Alliance Northern Territory ; Alice Springs ; Northern Territory ; Australia
  8. Western Australian Centre for Rural Health ; University of Western Australia ; Geraldton ; Western Australia ; Australia
  9. Aboriginal Health Council of South Australia ; Adelaide ; South Australia ; Australia
  
• 关键词：Quality improvement ; Aboriginal & Torres Strait Islander populations ; Type 2 diabetes mellitus ; Primary health care ; Variation in care
• 刊名：BMC Health Services Research
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：830 KB
• 参考文献：1. Speight, J, Browne, J, Holmes-Truscott, E, Hendrieckx, C, Pouwer, F (2011) Diabetes MILES 鈥?Australia 2011 Survey Report. Diabetes Australia, Melbourne
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  20. Larkins, S, Patrao, T, Thompson, S, Elston, J, Connors, C, Ward, J, Matthews, V, Kwedza, R, Bailie, R (釁? Understanding quality improvement in Aboriginal and Torres Strait Islander primary health care: lessons from the best to better the rest [abstract]. 釁? PHCRIS conference: 10鈥?2 July 2013, Sydney
  
• 刊物主题：Public Health; Health Administration; Health Informatics; Nursing Management/Nursing Research;
• 出版者：BioMed Central
• ISSN：1472-6963

文摘

Background It 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. Methods We 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. Results Health 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%. Conclusions At 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.