Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services

BMC Health Services Research

Julia V Marley²  Maureen Davey¹  David Atkinson²  Alice Stoneman³ 

[1] School of Medicine, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia;Kimberley Aboriginal Medical Services Council, 12 Napier Terrace, PO Box 1377, Broome, WA 6725, Australia;Launceston Clinical School, University of Tasmania, Locked Bag 1377, Launceston, TAS 7250, Australia

关键词: Primary health care;    Quality improvement cycles;    Diabetes;    Torres Strait Islander;    Aboriginal;    Indigenous;   

Others  :  1125945
DOI  :  10.1186/1472-6963-14-481

 received in 2014-03-27, accepted in 2014-09-29,  发布年份 2014

【 摘 要 】

Background

Management of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. We have previously demonstrated that diabetes monitoring and outcomes can be improved and maintained over a 10-year period at Derby Aboriginal Health Service (DAHS). While continuous quality improvement (CQI) has been shown to improve service delivery rates and clinical outcome measures, the process of interpreting audit results and developing strategies for improvement is less well described. This paper describes the evaluation of care of patients with type 2 diabetes mellitus (T2DM) and features of effective CQI in ACCHSs in the remote Kimberley region of north Western Australia.

Methods

Retrospective audit of records for Aboriginal and Torres Strait Islander primary care patients aged ≥15 years with a confirmed diagnosis of T2DM at four Kimberley ACCHSs from 1 July 2011 to 30 June 2012. Interviews with health service staff and focus group discussions with patients post audit. Main outcome measures: diabetes care related activities, clinical outcome measures and factors influencing good diabetes related care and effective CQI.

Results

A total of 348 patients from the four ACCHSs were included in the study. Clinical care activities were generally high across three of the four health services (at least 71% of patients had cholesterol recorded, 89% blood pressure, 84% HbA_1c). Patients from DAHS had lower median cholesterol levels (4.4 mmol/L) and the highest proportion of patients meeting clinical targets for HbA_1c (31% v 16% ACCHS-3; P = 0.02). Features that facilitated good care included clearly defined staff roles for diabetes management, support and involvement of Aboriginal Health Workers, efficient recall systems, and well-coordinated allied health services. Effective CQI features included seamless and timely data collection, local ownership of the process, openness to admitting deficiencies and willingness to embrace change.

Conclusions

Well-designed health care delivery and CQI systems, with a strong sense of ownership over diabetes management led to increased service delivery rates and improved clinical outcome measures in ACCHSs. Locally run CQI processes may be more responsive to individual health services and more sustainable than externally driven systems.

【 授权许可】

   
2014 Stoneman et al.; licensee BioMed Central Ltd.

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