title: Quality indicators of diabetes care: an example of remote-area Aboriginal primary health care over 10 years.
abstract: OBJECTIVE
  To describe service characteristics of Derby Aboriginal Health Service (DAHS) and document diabetes management activities and intermediate clinical outcomes for Aboriginal patients with type 2 diabetes.
  
  
  METHODS
  Retrospective audit of records for patients ≥ 15 years old who had a confirmed diagnosis of type 2 diabetes, received primary health care from DAHS for at least 6 continuous months between 1 July 1999 and 30 June 2009, resided in the Derby area and were not on renal replacement therapy.
  
  
  METHODS
  Electronic records of blood pressure (BP), glycated haemoglobin (HbA(1c)) level, weight, albumin-creatinine ratio, creatinine level or estimated glomerular filtration rate, lipid levels and smoking status during each audit year; and proportions of patients who met clinical targets for HbA(1c), BP and cholesterol.
  
  
  RESULTS
  Over the 10 years, the proportion of clinical care activities undertaken according to regional protocols increased significantly, with very high levels recorded in the last 3 years (at least 70% of patients had each activity recorded). There were significant improvements in systolic BP, diastolic BP and cholesterol levels over the 10 years (P < 0.001 for all). In the final year, 69% of patients had at least half their BP measurements ≤ 130/80 mmHg and 83% had median annual cholesterol levels of < 5.5 mmol/L. There were small improvements in HbA(1c) levels that approached statistical significance (P = 0.05). In the final year, 34% of patients had median annual HbA(1c) levels of ≤ 7.0%.
  
  
  CONCLUSIONS
  This study shows that diabetes monitoring and outcomes can be improved and maintained over a 10-year period in a well supported remote Aboriginal community-controlled health service setting.
authors.affiliation: Rural Clinical School of Western Australia, University of Western Australia, Broome, WA, Australia. Julia.Marley@rcswa.edu.au
authors.forename: Julia V
authors.initials: JV
authors.lastname: Marley
authors.forename: Carmel
authors.initials: C
authors.lastname: Nelson
authors.forename: Vicki
authors.initials: V
authors.lastname: O'Donnell
authors.forename: David
authors.initials: D
authors.lastname: Atkinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult