Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre-based continuous quality improvement approach

BMC Health Services Research

Ross S Bailie⁶  Jonathan R Carapetis²  Keith N Edwards⁸  Malcolm I McDonald¹  Michele Clark⁷  Matthew G Parnaby⁸  Tom Clemens⁸  Michelle Dowden³  Dale Thompson⁶  Rosalie Schultz⁵  Marea Fittock⁶  Anna P Ralph⁴ 

[1] School of Medicine and Dentistry, Cairns Campus, James Cook University, Townsville, QLD, Australia;Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia;Ngalkanbuy Health Service, Galiwinku, NT, Australia;Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia;Nyangirru Piliyi-ngara Kurantta, Anyinginyi Health Aboriginal Corporation, Tennant Creek, NT, Australia;Menzies School of Health Research, Darwin, Northern Territory (NT), Australia;Queensland Health, Queensland Government, Townsville, Queensland, Australia;Northern Territory Department of Health and Community Services, Townsville, Australia

关键词: Secondary prophylaxis;    Rheumatic heart disease;    Rheumatic fever;    Continuous quality improvement;   

Others  :  1134439
DOI  :  10.1186/1472-6963-13-525

 received in 2012-12-20, accepted in 2013-11-29,  发布年份 2013

【 摘 要 】

Background

Rheumatic heart disease (RHD) remains a major health concern for Aboriginal Australians. A key component of RHD control is prevention of recurrent acute rheumatic fever (ARF) using long-term secondary prophylaxis with intramuscular benzathine penicillin (BPG). This is the most important and cost-effective step in RHD control. However, there are significant challenges to effective implementation of secondary prophylaxis programs. This project aimed to increase understanding and improve quality of RHD care through development and implementation of a continuous quality improvement (CQI) strategy.

Methods

We used a CQI strategy to promote implementation of national best-practice ARF/RHD management guidelines at primary health care level in Indigenous communities of the Northern Territory (NT), Australia, 2008–2010. Participatory action research methods were employed to identify system barriers to delivery of high quality care. This entailed facilitated discussion with primary care staff aided by a system assessment tool (SAT). Participants were encouraged to develop and implement strategies to overcome identified barriers, including better record-keeping, triage systems and strategies for patient follow-up. To assess performance, clinical records were audited at baseline, then annually for two years. Key performance indicators included proportion of people receiving adequate secondary prophylaxis (≥80% of scheduled 4-weekly penicillin injections) and quality of documentation.

Results

Six health centres participated, servicing approximately 154 people with ARF/RHD. Improvements occurred in indicators of service delivery including proportion of people receiving ≥40% of their scheduled BPG (increasing from 81/116 [70%] at baseline to 84/103 [82%] in year three, p = 0.04), proportion of people reviewed by a doctor within the past two years (112/154 [73%] and 134/156 [86%], p = 0.003), and proportion of people who received influenza vaccination (57/154 [37%] to 86/156 [55%], p = 0.001). However, the proportion receiving ≥80% of scheduled BPG did not change. Documentation in medical files improved: ARF episode documentation increased from 31/55 (56%) to 50/62 (81%) (p = 0.004), and RHD risk category documentation from 87/154 (56%) to 103/145 (76%) (p < 0.001). Large differences in performance were noted between health centres, reflected to some extent in SAT scores.

Conclusions

A CQI process using a systems approach and participatory action research methodology can significantly improve delivery of ARF/RHD care.

【 授权许可】

   
2013 Ralph et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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