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

Ross Bailie, Veronica Matthews, Sarah Larkins, Sandra Thompson, Paul Burgess, Tarun Weeramanthri, Jodie Bailie, Frances Cunningham, Ru Kwedza, Louise Clark

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish
Article numbere016626
JournalBMJ Open
Volume7
Issue number10
DOIs
Publication statusPublished - 1 Oct 2017

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Quality of Health Care
Quality Improvement
Practice Guidelines
Primary Health Care
Research
Linear Models
Chronic Disease
Regression Analysis
Outcome Assessment (Health Care)
Health

Cite this

Bailie, Ross ; Matthews, Veronica ; Larkins, Sarah ; Thompson, Sandra ; Burgess, Paul ; Weeramanthri, Tarun ; Bailie, Jodie ; Cunningham, Frances ; Kwedza, Ru ; Clark, Louise. / 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. In: BMJ Open. 2017 ; Vol. 7, No. 10.
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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; Clark, Louise.

In: BMJ Open, Vol. 7, No. 10, e016626, 01.10.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of policy support on uptake of evidence-based continuous quality improvement activities and the quality of care for Indigenous Australians

T2 - A comparative case study

AU - Bailie, Ross

AU - Matthews, Veronica

AU - Larkins, Sarah

AU - Thompson, Sandra

AU - Burgess, Paul

AU - Weeramanthri, Tarun

AU - Bailie, Jodie

AU - Cunningham, Frances

AU - Kwedza, Ru

AU - Clark, Louise

PY - 2017/10/1

Y1 - 2017/10/1

N2 - 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.

AB - 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.

KW - Aboriginal and Torres Strait Islander health

KW - continuous quality improvement

KW - health policy

KW - primary health care

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SN - 2044-6055

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