BackgroundStrengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE) project has facilitated the implementation of modern Continuous Quality Improvement (CQI) approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes. It has also highlighted substantial variation in quality of care. Through a partnership between academic researchers, service providers and policy makers, we are now implementing a study which aims to 1) explore the factors associated with variation in clinical performance; 2) examine specific strategies that have been effective in improving primary care clinical performance; and 3) work with health service staff, management and policy makers to enhance the effective implementation of successful strategies.Methods/DesignThe study will be conducted in Indigenous community health centres from at least six States/Territories (Northern Territory, Western Australia, New South Wales, South Australia, Queensland and Victoria) over a five year period. A research hub will be established in each region to support collection and reporting of quantitative and qualitative clinical and health centre system performance data, to investigate factors affecting variation in quality of care and to facilitate effective translation of research evidence into policy and practice. The project is supported by a web-based information system, providing automated analysis and reporting of clinical care performance to health centre staff and management.DiscussionBy linking researchers directly to users of research (service providers, managers and policy makers), the partnership is well placed to generate new knowledge on effective strategies for improving the quality of primary health care and fostering effective and efficient exchange and use of data and information among service providers and policy makers to achieve evidence-based resource allocation, service planning, system development, and improvements of service delivery and Indigenous health outcomes.

Objective To assess the association of reported smoking cessation at various time points during pregnancy with fetal growth restriction (FGR). Methods This was a population-based retrospective cohort study of singleton nonanomalous live births using Ohio birth certificates, 2006–2012. Outcomes of women who reported smoking only in the 3 months before conception and women who reported smoking through the first, second, or third trimester were compared to a referent group of nonsmokers. Multivariate logistic regression assessed the association between smoking cessation at various times in pregnancy and FGR less than the 10th and 5th percentiles. Results Of 927,424 births analyzed, 75% did not smoke. Of smokers, 24% smoked preconception only, 10% quit after the 1st trimester, 4% quit after the 2nd trimester, and 59% smoked throughout pregnancy. The rate of FGR less than the 10th and 5th percentiles among non-smokers was 8.1% and 3.6%, respectively. Although smoking only in the preconception period did not significantly increase FGR risk, smoking in any trimester did. The adjOR(95%CI) for FGR less than the 10th and 5th percentiles, respectively, of cessation after the 1st trimester was 1.19(1.13,1.24) and 1.25(1.17,1.33), and 1.67(1.57,1.78) and 1.83(1.68,1.99) for cessation after the second trimester. Women who reported smoking throughout pregnancy had the highest risks of FGR, 2.26 (2.22,2.31) and 2.44(2.37,2.51), after accounting for the influence of race, low socioeconomic status, and medical comorbidities. Conclusions Smoking of any duration during pregnancy is associated with an increased risk of FGR, with decreasing risk the earlier that cessation occurs. Smoking cessation programs should focus on the benefit of quitting as early in pregnancy as possible.