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

Abstract

ObjectivesTo 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.DesignMixed-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.SettingIndigenous primary healthcare services across five states/territories of Australia.Participants175 Indigenous primary healthcare services.InterventionsA 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).ResultsProgressive 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.ConclusionsHealth 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.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

“…Ideally, CQI action and engagement occur within and between health service, regional and national levels of the health system, addressing systemic barriers within local contexts ( 11 ). In the Northern Territory, consistent and sustained policy and infrastructure support for CQI have resulted in a progressive uptake of evidence-based CQI activities and a stronger improvement of health-care performance than that of other jurisdictions ( 26 , 27 ). Performance improvement is attributed in large part to improved decision-making facilitated by the active and timely engagement of primary health-care teams in collation, analysis, participatory interpretation, and reporting of good quality local health care and health outcome data.…”

A systematic review of approaches to improve practice, detection and treatment of unhealthy alcohol use in primary health care: a role for continuous quality improvement

“…CQI is designed to improve health care by using data to identify where services are doing well and not so well, implementing and monitoring corrective action and then reviewing its effectiveness, in continuous improvement cycles. Studies, including the largest CQI program in Australia [16], have shown that with consistent policy and infrastructure it can facilitate ongoing improvement of PHC service delivery and subsequently, better health outcomes [16][17][18][19]. This largest program includes research in Aboriginal community controlled primary health care services [16].…”

“…Studies, including the largest CQI program in Australia [16], have shown that with consistent policy and infrastructure it can facilitate ongoing improvement of PHC service delivery and subsequently, better health outcomes [16][17][18][19]. This largest program includes research in Aboriginal community controlled primary health care services [16]. However, to our knowledge, there is no literature review specifically on the use of CQI strategies in improving service provision for unhealthy alcohol use in the PHC setting.…”

Editorial: Continuous Quality Improvement (CQI)—Advancing Understanding of Design, Application, Impact, and Evaluation of CQI Approaches

“…Primary drivers included staff capability, availability and use of information systems and decision support tools, embedding of CQI processes, and community engagement. We have also shown how consistent and sustained policy and infrastructure support for CQI enables large-scale and ongoing improvements in quality of care ( 3 ).…”

“…Among a range of quality improvement strategies, CQI is characterized by iterative use of processes to identify quality problems, develop solutions, and implement and evaluate changes. Application of CQI in health care is evolving and evidence of their success continues to emerge ( 1 – 3 ).…”