title: Improving physiotherapy services to Indigenous children with physical disability: Are client perspectives missed in the continuous quality improvement approach?
abstract: OBJECTIVE
  To compare the outcomes of two cycles of continuous quality improvement (CQI) at a paediatric physiotherapy service with findings from interviews with clients and their carers using the service.
  
  
  METHODS
  Case study based at one paediatric physiotherapy service
  
  
  METHODS
  Community-based paediatric allied health service in Northern Australia.
  
  
  METHODS
  Forty-nine clinical records and four staff at physiotherapy service, five Indigenous children with physical disability aged 8-21 years, and nine carers of Indigenous children aged 0-21 years (current or previous clients).
  
  
  METHODS
  The CQI process based on the Audit and Best Practice for Chronic Disease involved a clinical audit; a workshop where clinicians assessed their health care systems, identified weaknesses and strengths, and developed goals and strategies for improvement; and reassessment through a second audit and workshop. Twelve open-ended, in-depth interviews were conducted with previous or current clients selected through purposive and theoretical sampling. CQI and interview results were then compared.
  
  
  METHODS
  Comparison of findings from the two studies
  
  
  RESULTS
  Both CQI and interview results highlighted service delivery flexibility and therapists' knowledge, support and advocacy as service strengths, and lack of resources and a child-friendly office environment as weaknesses. However, the CQI results reported better communication and client input into the service than the interview results.
  
  
  CONCLUSIONS
  The CQI process, while demonstrating improvements in clinical and organisational aspects of the service, did not always reflect or address the primary concerns of Indigenous clients and underlined the importance of including clients in the CQI process.
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Caroline
authors.initials: C
authors.lastname: Greenstein
authors.affiliation: Research Centre for Health and Wellbeing, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Lowell
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: David Piers
authors.initials: DP
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000592:standards*; D019988:Children with Disabilities / Q000534:rehabilitation; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008485:Medical Audit; D015876:Northern Territory; D026741:Physical Therapy Modalities / Q000592:standards*; D058996:Quality Improvement; D017749:Total Quality Management; D055815:Young Adult
keywords: Aboriginal; Oceanic Ancestry Group; allied health; paediatric; physical therapy (specialty)