Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities

Implementation Science

Stephanie Brown²  Rhonda Small⁹  I-Hao Cheng⁷  Sue Willey⁵  Mary Anne Biro⁵  Fiona Mensah⁴  Sharon Goldfeld^1,10  John Furler²  Pauline Petschel⁶  Bernie Harrison^1,11  Glyn Teale^1,13  Euan Wallace³  Chris East¹  Dannielle Vanpraag⁸  Wendy Dawson⁸  Sue Casey^1,12  Josef Szwarc^1,12  Elisha Riggs²  Jane Yelland² 

[1] The Ritchie Centre, Monash University, Clayton, VIC, Australia;Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia;Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia;Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, VIC, Australia;School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia;Maternal and Child Health, City of Wyndham, Wyndham, VIC, Australia;Southern Academic Primary Care Research Unit, Monash University, Dandenong, VIC, Australia;Healthy Mothers Healthy Families Research Group, Murdoch Children’s Research Institute, Parkville 3052, , VIC, Australia;Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia;Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia;Maternal and Child Health, City of Greater Dandenong, Dandenong, VIC, Australia;Victorian Foundation for Survivors of Torture, Brunswick, VIC, Australia;Department Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia

关键词: Process evaluation;    Time series design;    Refugee families;    Universal health services;    Partnerships;    Quality improvement;   

Others  :  1218381
DOI  :  10.1186/s13012-015-0251-z

 received in 2015-03-26, accepted in 2015-04-18,  发布年份 2015

【 摘 要 】

Background

The risk of poor maternal and perinatal outcomes in high-income countries such as Australia is greatest for those experiencing extreme social and economic disadvantage. Australian data show that women of refugee background have higher rates of stillbirth, fetal death in utero and perinatal mortality compared with Australian born women. Policy and health system responses to such inequities have been slow and poorly integrated. This protocol describes an innovative programme of quality improvement and reform in publically funded universal health services in Melbourne, Australia, that aims to address refugee maternal and child health inequalities.

Methods/design

A partnership of 11 organisations spanning health services, government and research is working to achieve change in the way that maternity and early childhood health services support families of refugee background. The aims of the programme are to improve access to universal health care for families of refugee background and build organisational and system capacity to address modifiable risk factors for poor maternal and child health outcomes. Quality improvement initiatives are iterative, co-designed by partners and implemented using the Plan Do Study Act framework in four maternity hospitals and two local government maternal and child health services.

Bridging the Gap is designed as a multi-phase, quasi-experimental study. Evaluation methods include use of interrupted time series design to examine health service use and maternal and child health outcomes over a 3-year period of implementation. Process measures will examine refugee families’ experiences of specific initiatives and service providers’ views and experiences of innovation and change.

Discussion

It is envisaged that the Bridging the Gap program will provide essential evidence to support service and policy innovation and knowledge about what it takes to implement sustainable improvements in the way that health services support vulnerable populations, within the constraints of existing resources.

【 授权许可】

   
2015 Yelland et al.; licensee BioMed Central.

【 图 表 】

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