title: Assessing quality of diabetes care and its variation in Aboriginal community health centres in Australia.
abstract: BACKGROUND
  Examining variation in diabetes care across regions/organizations provides insight into underlying factors related to quality of care. The aims of this study were to assess quality of diabetes care and its variation among Aboriginal community health centres in Australia, and to estimate partitioning of variation attributable to health centre and individual patient characteristics.
  
  
  METHODS
  During 2005-2009, clinical medical audits were conducted in 62 Aboriginal community health centres from four states/territories. Main outcome measures include adherence to guidelines-scheduled processes of diabetes care, treatment and medication adjustment, and control of HbA(1c), blood pressure, total cholesterol and albumin/creatinine ratio (ACR).
  
  
  RESULTS
  Wide variation was observed across different categories of diabetes care measures and across centres: (1) overall adherence to delivery of services averaged 57% (range 22-83% across centres); (2) medication adjustment rates after elevated HbA(1c): 26% (0-72%); and (3) proportions of patients with HbA(1c) < 7%:27% (0-55%); with blood pressure < 130/80 mmHg: 36% (0-59%). Health centre level characteristics accounted for 36% of the total variation in adherence to process measures, and 3-11% of the total variation in patient intermediate outcomes; the remaining, substantial amount of variation in each measure was attributable to patient level characteristics.
  
  
  CONCLUSIONS
  Deficiencies in a range of quality of care measures provide multiple opportunities for improvement. The majority of variation in quality of diabetes care appears to be attributable to patient level characteristics. Further understanding of factors affecting variation in the care of individuals should assist clinicians, managers and policy makers to develop strategies to improve quality of diabetes care in Aboriginal communities.
authors.affiliation: Charles Darwin University, NT, Australia. damin.si@menzies.edu.au
authors.forename: Damin
authors.initials: D
authors.lastname: Si
authors.forename: Ross
authors.initials: R
authors.lastname: Bailie
authors.forename: Michelle
authors.initials: M
authors.lastname: Dowden
authors.forename: Catherine
authors.initials: C
authors.lastname: Kennedy
authors.forename: Rhonda
authors.initials: R
authors.lastname: Cox
authors.forename: Lynette
authors.initials: L
authors.lastname: O'Donoghue
authors.forename: Helen
authors.initials: H
authors.lastname: Liddle
authors.forename: Ru
authors.initials: R
authors.lastname: Kwedza
authors.forename: Christine
authors.initials: C
authors.lastname: Connors
authors.forename: Sandra
authors.initials: S
authors.lastname: Thompson
authors.forename: Hugh
authors.initials: H
authors.lastname: Burke
authors.forename: Alex
authors.initials: A
authors.lastname: Brown
authors.forename: Tarun
authors.initials: T
authors.lastname: Weeramanthri
mesh_terms: D001315:Australia; D054869:Clinical Audit; D003151:Community Health Centers / Q000592:standards*; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence; D006303:Health Services, Indigenous / Q000592:standards*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000592:standards; D019984:Quality Indicators, Health Care
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human