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

Matthews, Veronica, Schierhout, Gill, McBroom, James, Connors, Christine, Kennedy, Catherine, Kwedza, Ru, Larkins, Sarah, Moore, Elizabeth, Thompson, Sandra, Scrimgeour, David, and Bailie, Ross (2014) Duration of participation in continuous quality improvement: a key factor explaining improved delivery of Type 2 diabetes services. BMC Health Services Research, 14. 578. pp. 1-12.

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Abstract

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.

Item ID: 36897
Item Type: Article (Research - C1)
ISSN: 1472-6963
Keywords: quality improvement, Aboriginal & Torres Strait Islander populations, type 2 diabetes mellitus, primary health care, variation in care
Additional Information:

© 2014 Matthews et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Funders: National Health and Medical Research Council (NHMRC), Lowitja Institute, Australian Research Council (ARC)
Projects and Grants: NHMRC 545267, ARC FT100100087
Date Deposited: 11 Mar 2015 02:52
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 50%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111701 Aboriginal and Torres Strait Islander Health @ 50%
SEO Codes: 92 HEALTH > 9203 Indigenous Health > 920303 Aboriginal and Torres Strait Islander Health - Health System Performance (incl. Effectiveness of Interventions) @ 100%
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