Impact of policy support on uptake of evidence-based continuous quality improvement activities and the quality of care for Indigenous Australians: a comparative case study.

Bailie, Ross, Matthews, Veronica, Larkins, Sarah, Thompson, Sandra, Burgess, Paul, Weeramanthri, Tarun, Bailie, Jodie, Cunningham, Frances, Kwedza, Ru, and Clark, Louise (2017) Impact of policy support on uptake of evidence-based continuous quality improvement activities and the quality of care for Indigenous Australians: a comparative case study. BMJ Open, 7 (10).

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Abstract

Objectives: To examine the impact of state/territory policy support on (1) uptake of evidence-based continuous quality improvement (CQI) activities and (2) quality of care for Indigenous Australians.

Design: Mixed-method comparative case study methodology, drawing on quality-of-care audit data, documentary evidence of policies and strategies and the experience and insights of stakeholders involved in relevant CQI programmes. We use multilevel linear regression to analyse jurisdictional differences in quality of care.

Setting: Indigenous primary healthcare services across five states/territories of Australia.

Participants: 175 Indigenous primary healthcare services.

Interventions: A range of national and state/territory policy and infrastructure initiatives to support CQI, including support for applied research.

Primary and secondary outcome measures: (i) Trends in the consistent uptake of evidence-based CQI tools available through a research-based CQI initiative (the Audit and Best Practice in Chronic Disease programme) and (ii) quality of care (as reflected in adherence to best practice guidelines).

Results: Progressive uptake of evidence-based CQI activities and steady improvements or maintenance of high-quality care occurred where there was long-term policy and infrastructure support for CQI. Where support was provided but not sustained there was a rapid rise and subsequent fall in relevant CQI activities.

Conclusions: Health authorities should ensure consistent and sustained policy and infrastructure support for CQI to enable wide-scale and ongoing improvement in quality of care and, subsequently, health outcomes. It is not sufficient for improvement initiatives to rely on local service managers and clinicians, as their efforts are strongly mediated by higher system-level influences.

Item ID: 51571
Item Type: Article (Research - C1)
ISSN: 2044-6055
Additional Information:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Funders: National Health and Medical Research Council (NHMRC), Lowitja Institute
Projects and Grants: NHMRC 545267, NHMRC 1078927
Date Deposited: 16 Nov 2017 23:07
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111701 Aboriginal and Torres Strait Islander Health @ 50%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 50%
SEO Codes: 92 HEALTH > 9203 Indigenous Health > 920303 Aboriginal and Torres Strait Islander Health - Health System Performance (incl. Effectiveness of Interventions) @ 60%
92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920506 Rural Health @ 40%
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