Objective: To evaluate the impact of an intervention to improve chronic illness care in Aboriginal community health centres.
Methods: A prospective study in 12 Aboriginal community health centres with a random sample of 360 well adults and 295 patients with type 2 diabetes. The intervention consisted of a cycle featuring service systems assessment, clinical audit and feedback, organisational learning, goal setting for system changes, and implementation of changes in practices. Multilevel analysis was used to account for repeated observations and clustering.
Principal Findings: Health centre systems improved across all areas assessed, with significant improvement in areas of delivery system design and clinical information systems. There were improvements in process and intermediate outcome measures for people with diabetes: HbA1c check within 6 months increased from 41% to 75%; BP check within 3 months increased from 63% to 78%; percentage with HbA1c<7% increased from19% to 28%. Little improvement was found in blood pressure and total cholesterol control for people with diabetes or in delivery of preventive services to the generally well adult population.
Discussion: This multifaceted intervention achieved favourable changes in health centre systems and in some process and outcome measures of diabetes care within a two year period. Impact on preventive services was limited. Comparison with non-intervention communities (data under analysis) will provide a stronger basis for assessment of impact.
Implications for Policy and Practice: Understanding the requirements for wide implementation of this type of quality improvement initiative is critical to the development of policy and practice, and is the subject of the current national extension phase of the project. The experience and approach of the project has already informed the development of the national Healthy for Life Program - a Commonwealth government funded quality improvement initiative targeting maternal and child health and chronic illness in Indigenous primary care services.
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