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Improving Services to Aboriginal and Torres Strait Islander Peoples: The ABCD Extension Project. Background to the ABCD Extension Project (1). Poor health outcomes Lack of consistent measures of quality of care Impact of interventions is often not sustained - PowerPoint PPT Presentation
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Improving Services to Aboriginal and Torres Strait Islander Peoples:
The ABCD Extension Project
• Poor health outcomes
• Lack of consistent measures of quality of care
• Impact of interventions is often not sustained
• Modern CQI as a potential strategy in PHC
Background to the ABCD Extension Project (1)
Background to the ABCD Extension Project (2)
• Original ABCD Project (2002 – 2006)– Examined feasibility and impact of applying modern
QI approaches in Indigenous PHC
• Findings• Systematic approach to using audit and system assessment
tools is feasible• Results in improvement in
– Health centre systems – Adherence to best practice guidelines in service delivery– Intermediate health outcomes
• Wider implementation
• Additional tools
• Integrate process into routine activity
• Research on factors affecting uptake and
sustainability of impacts
• 2005 - 2009
Aims of the ABCD Extension Project
ABCD Extension Project: Approach STEP 1:
Signed Agreement
STEP 2:Training/
Orientation
STEP 6: actImplement changes
STEP 5: Action Planning. Clinic
feedback, workshop & goal setting for system
changes
STEP 4: Participatory Interpretation.
Data analysis & report preparation
STEP 3:Audits, system
assessment
Project implemented through regional hubs:
•Top End
• Central Australia
• Far West NSW
• WA
• North QLD
MELBOURNE
DARWIN
BRISBANE
HOBART
SYDNEY
CANBERRAADELAIDE
PERTH
ABCD Site
ABCD associated sites
ABCD tools only
• Participatory Action Research
• Clinical Audits
• Systems Assessment
• Observation by Hub Coordinators
quarterly reports; scoring on key factors; structured dialogue
• In-depth Interviews (largely focused on two regions)
practitioners, health centre managers and staff, policy makers, Hub Coordinators, researchers
Research Methods
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Trends for overall delivery of preventive services:
All services with 3+ rounds of audit data
Preliminary findings from preventive services audits
36 services which completed three rounds of audits (n = 1024-1129 client records
Baseline Round 3 audit
Change: Baseline to round 3
Overall adherence
31% 44% 13% (p<0.01)
BP check in last year
65% 74% 11% (p=0.07)
Follow up of abnormal BP
19% 37% 18% (p<0.01)
Follow up of proteinuria
22% 63% 41% (p<0.01)
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Trends for overall delivery of preventive services:
Selected services with 3+ rounds of audit data
Preliminary findings: Key factors explaining
improvement in preventive services
• Leadership for QI (Medical and Management)
• Population health approach
• Regional level support systems
• Involvement of AHWs in preventive care
• Complete analysis
• ABCD Extension Project Final Report
• Other dissemination
• Integrate lessons into One21seventy service support
• ABCD Research Partnership Improving practice through research
What next?
