PMID- 25288282
OWN - NLM
STAT- MEDLINE
DCOM- 20150512
LR  - 20211203
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 14
DP  - 2014 Oct 7
TI  - Quality improvement in practice: improving diabetes care and patient outcomes in 
      Aboriginal Community Controlled Health Services.
PG  - 481
LID - 10.1186/1472-6963-14-481 [doi]
LID - 481
AB  - 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% HbA1c). Patients from DAHS had lower median cholesterol 
      levels (4.4 mmol/L) and the highest proportion of patients meeting clinical 
      targets for HbA1c (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.
FAU - Stoneman, Alice
AU  - Stoneman A
AD  - Launceston Clinical School, University of Tasmania, Locked Bag 1377, Launceston, 
      TAS 7250, Australia. alice.stoneman90@gmail.com.
FAU - Atkinson, David
AU  - Atkinson D
FAU - Davey, Maureen
AU  - Davey M
FAU - Marley, Julia V
AU  - Marley JV
LA  - eng
PT  - Journal Article
DEP - 20141007
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Australia
MH  - Delivery of Health Care/*standards
MH  - Diabetes Mellitus, Type 2/drug therapy/*ethnology
MH  - Female
MH  - Focus Groups
MH  - Humans
MH  - Interviews as Topic
MH  - Male
MH  - Medical Audit
MH  - Middle Aged
MH  - *Native Hawaiian or Other Pacific Islander
MH  - Qualitative Research
MH  - *Quality Improvement
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Young Adult
PMC - PMC4282197
EDAT- 2014/10/08 06:00
MHDA- 2015/05/13 06:00
PMCR- 2014/10/07
CRDT- 2014/10/08 06:00
PHST- 2014/03/27 00:00 [received]
PHST- 2014/09/29 00:00 [accepted]
PHST- 2014/10/08 06:00 [entrez]
PHST- 2014/10/08 06:00 [pubmed]
PHST- 2015/05/13 06:00 [medline]
PHST- 2014/10/07 00:00 [pmc-release]
AID - 1472-6963-14-481 [pii]
AID - 3562 [pii]
AID - 10.1186/1472-6963-14-481 [doi]
PST - epublish
SO  - BMC Health Serv Res. 2014 Oct 7;14:481. doi: 10.1186/1472-6963-14-481.