title: Monitoring and assessing the quality of care for youth: developing an audit tool using an expert consensus approach.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  Audit 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.
  
  
  RESULTS
  Audit 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Menzies School of Health Research, PO Box 41096, Casuarina, NT 0810 Australia.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Puszka
authors.affiliation: Menzies School of Health Research, PO Box 41096, Casuarina, NT 0810 Australia.
authors.forename: Tricia
authors.initials: T
authors.lastname: Nagel
authors.affiliation: Menzies School of Health Research, PO Box 41096, Casuarina, NT 0810 Australia.
authors.forename: Veronica
authors.initials: V
authors.lastname: Matthews
authors.affiliation: Menzies School of Health Research, PO Box 41096, Casuarina, NT 0810 Australia ; One21seventy, The National Centre for Quality Improvement in Indigenous Primary Health Care, PO Box 10639, Adelaide Street, Brisbane, QLD 4000 Australia.
authors.forename: Diana
authors.initials: D
authors.lastname: Mosca
authors.affiliation: Watto Purrunna Aboriginal Health Service, Northern Adelaide Local Health Network, SA Health, 1 Gilles Crescent, Hillcrest, SA 5086 Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Piovesan
authors.affiliation: Watto Purrunna Aboriginal Health Service, Northern Adelaide Local Health Network, SA Health, 1 Gilles Crescent, Hillcrest, SA 5086 Australia.
authors.forename: Annapurna
authors.initials: A
authors.lastname: Nori
authors.affiliation: Menzies School of Health Research, PO Box 41096, Casuarina, NT 0810 Australia ; One21seventy, The National Centre for Quality Improvement in Indigenous Primary Health Care, PO Box 10639, Adelaide Street, Brisbane, QLD 4000 Australia.
authors.forename: Ross
authors.initials: R
authors.lastname: Bailie
keywords: Adolescent health services; Clinical audit; Indigenous health; Primary healthcare; Quality improvement; Quality indicators; Standard of care