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

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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.

    Original languageEnglish
    Article numbere016626
    Pages (from-to)1-11
    Number of pages11
    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. pp. 1-11.
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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.",
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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, p. 1-11.

    Research output: Contribution to journalArticleResearchpeer-review

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