title: Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence.
abstract: OBJECTIVE
  To review the literature on different models of clinical governance and to explore their relevance to Australian primary health care, and their potential contributions on quality and safety.
  
  
  METHODS
  25 electronic databases, scanning reference lists of articles and consultation with experts in the field. We searched publications in English after 1999, but a search of the German language literature for a specific model type was also undertaken. The grey literature was explored through a hand search of the medical trade press and websites of relevant national and international clearing houses and professional or industry bodies. 11 software packages commonly used in Australian general practice were reviewed for any potential contribution to clinical governance.
  
  
  METHODS
  19 high-quality studies that assessed outcomes were included.
  
  
  METHODS
  All abstracts were screened by one researcher, and 10% were screened by a second researcher to crosscheck screening quality. Studies were reviewed and coded by four reviewers, with all studies being rated using standard critical appraisal tools such as the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Two researchers reviewed the Australian general practice software. Interviews were conducted with 16 informants representing service, regional primary health care, national and international perspectives.
  
  
  RESULTS
  Most evidence supports governance models which use targeted, peer-led feedback on the clinician's own practice. Strategies most used in clinical governance models were audit, performance against indicators, and peer-led reflection on evidence or performance.
  
  
  CONCLUSIONS
  The evidence base for clinical governance is fragmented, and focuses mainly on process rather than outcomes. Few publications address models that enhance safety, efficiency, sustainability and the economics of primary health care. Locally relevant clinical indicators, the use of computerised medical record systems, regional primary health care organisations that have the capacity to support the uptake of clinical governance at the practice level, and learning from the Aboriginal community-controlled sector will help integrate clinical governance into primary care.
authors.affiliation: Academic Unit of General Practice and Community Health, Medical School, Australian National University, Canberra, ACT, Australia. Christine.phillips@anu.edu.au
authors.forename: Christine B
authors.initials: CB
authors.lastname: Phillips
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Pearce
authors.forename: Sally
authors.initials: S
authors.lastname: Hall
authors.forename: Joanne
authors.initials: J
authors.lastname: Travaglia
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignan
authors.forename: Tom
authors.initials: T
authors.lastname: Love
authors.forename: Marjan
authors.initials: M
authors.lastname: Kljakovic
mesh_terms: D001315:Australia; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D017598:Efficiency, Organizational; D058006:General Practice / Q000458:organization & administration*; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration*; D058996:Quality Improvement