Monitoring and assessing the quality of care for youth: developing an audit tool using an expert consensus approach

Abstract

BackgroundThe mental health needs of young people are often inadequately met by health services. Quality improvement approaches provide a framework for measuring, assessing and improving the quality of healthcare. However, a lack of performance standards and measurement tools are an impediment to their implementation. This paper reports on the initial stages of development of a clinical audit tool for assessing the quality of primary healthcare for Australian Indigenous youth aged 12–24 including mental health services provided within primary care.MethodsAudit items were determined through review of relevant guidelines, expert reference group consensus opinion and specific inclusion criteria. Pilot testing was undertaken at four Indigenous primary healthcare services. A focus group discussion involving five staff from a health service participating in pilot testing explored user experiences of the tool.ResultsAudit items comprise key measures of processes and outcomes of care for Indigenous youth, as determined by the expert reference group. Gaps and conflicts in relevant guidelines and a lack of agreed performance indicators necessitated a tool development process that relied heavily on expert reference group advice and audit item inclusion criteria. Pilot testing and user feedback highlighted the importance of feasibility and context-specific considerations in tool development and design.ConclusionsThe youth health audit tool provides a first step in monitoring, assessing and improving the way Indigenous primary healthcare services engage with and respond to the needs of youth. Our approach offers a way forward for further development of quality measures in the absence of clearly articulated standards of care.

Implementation of continuous quality improvement in Aboriginal and Torres Strait Islander primary health care in Australia: a scoping systematic review

“…The non-peer reviewed literature ( n = 12) comprised 8 evaluations [ 15 , 24 , 34 , 37 , 39 , 42 , 57 , 67 ] and 4 technical reports [ 38 , 68 ]. In the black literature ( n = 48), the majority of publications are descriptive and baseline studies (58%, n = 28) that include study protocols [ 13 , 17 , 21 , 44 , 47 , 50 , 62 , 63 , 65 , 69 ], a history of CQI [ 18 ], a feasibility study [ 36 ] or baseline/single audit studies [ 12 , 19 , 23 , 25 , 26 , 28 – 30 , 32 , 40 , 45 , 52 , 53 , 60 ] or studies that did not report specifically on Indigenous services or clients [ 56 , 64 ]. One of the latter was a publication from the Australian Primary Care Collaborative [ 56 ], a major CQI program in Australian primary health care, that reported on changes for a completed 18-month collaborative over 13 ‘waves’ between 2005 to 2011 for 1132 general practices and 53 ACCHSs across Australia but results for the ACCHSs are not reported separately [ 56 ].…”

Performance Measurement in Mental Health and Addictions Systems: A Scoping Review

“…For instance, appropriateness (whether services are relevant to people’s needs and based on accepted standards/evidence) overlaps conceptually with effectiveness. In other frameworks, issues akin to appropriateness/effectiveness were captured through measures of core services specific to a given type of provider (e.g., primary care providers; Barnsley et al, 2005; Hogg et al, 2008; Puszka et al, 2015; Waraich et al, 2010), or to a given care setting (e.g., inpatient psychiatric liaison services; Solomons et al, 2011).…”

Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children: protocol for a community-driven continuous quality improvement approach

“…2) Systems integration -A modified Health Promotion Systems Assessment Tool (HPSA T) will be used to audit community-level leadership and governance, financing, workforce capacity, and health information infrastructure for systems integration, and networks and partnerships among agencies and with families and children [53]. 3) Children's SEWB concerns -modified child (5-11 years) health [69] and youth (12-17 years) health clinical audit tools [70] will be used to audit the PHC records of children's attendance at the health service, reason for attendance, and discussions/ brief intervention/ advice about SEWB in the last 12 months (modified to also audit concerns identified). The youth health clinical audit tool has a specific focus on SEWB and also incorporates items for mental health-related long-term health conditions and Fig.…”