title: Responses of Aboriginal and Torres Strait Islander Primary Health-Care Services to Continuous Quality Improvement Initiatives.
abstract: BACKGROUND
  Indigenous primary health-care (PHC) services participating in continuous quality improvement (CQI) cycles show varying patterns of performance over time. Understanding this variation is essential to scaling up and sustaining quality improvement initiatives. The aim of this study is to examine trends in quality of care for services participating in the ABCD National Research Partnership and describe patterns of change over time and examine health service characteristics associated with positive and negative trends in quality of care.
  
  
  METHODS
  PHC services providing care for Indigenous people in urban, rural, and remote northern Australia that had completed at least three annual audits of service delivery for at least one aspect of care (n = 73).
  
  
  METHODS
  Longitudinal clinical audit data from use of four clinical audit tools (maternal health, child health, preventive health, Type 2 diabetes) between 2005 and 2013 were analyzed. Health center performance was classified into six patterns of change over time: consistent high improvement (positive), sustained high performance (positive), decline (negative), marked variability (negative), consistent low performance (negative), and no specific increase or decrease (neutral). Backwards stepwise multiple logistic regression analyses were used to examine the associations between health service characteristics and positive or negative trends in quality of care.
  
  
  RESULTS
  Trends in quality of care varied widely between health services across the four audit tools. Regression analyses of health service characteristics revealed no consistent statistically significant associations of population size, remoteness, governance model, or accreditation status with positive or negative trends in quality of care.
  
  
  CONCLUSIONS
  The variable trends in quality of care as reflected by CQI audit tools do not appear to be related to easily measurable health service characteristics. This points to the need for a deeper or more nuanced understanding of factors that moderate the effect of CQI on health service performance for the purpose of strengthening enablers and overcoming barriers to improvement.
authors.affiliation: College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia; Anton Breinl Research Centre for Health Systems Strengthening, Australian Institute for Tropical Health and Medicine, Townsville, QLD, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Larkins
authors.affiliation: College of Medicine and Dentistry, James Cook University , Cairns, QLD , Australia.
authors.forename: Cindy E
authors.initials: CE
authors.lastname: Woods
authors.affiliation: Menzies School of Health Research , Brisbane, QLD , Australia.
authors.forename: Veronica
authors.initials: V
authors.lastname: Matthews
authors.affiliation: Western Australian Centre for Rural Health (WACRH), The University of Western Australia , Crawley, WA , Australia.
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Thompson
authors.affiliation: Menzies School of Health Research , Brisbane, QLD , Australia.
authors.forename: Gill
authors.initials: G
authors.lastname: Schierhout
authors.affiliation: School of Medicine, University of Queensland , Brisbane, QLD , Australia.
authors.forename: Maxwell
authors.initials: M
authors.lastname: Mitropoulos
authors.affiliation: Menzies School of Health Research , Brisbane, QLD , Australia.
authors.forename: Tania
authors.initials: T
authors.lastname: Patrao
authors.affiliation: College of Medicine and Dentistry, James Cook University , Cairns, QLD , Australia.
authors.forename: Annette
authors.initials: A
authors.lastname: Panzera
authors.affiliation: Menzies School of Health Research , Brisbane, QLD , Australia.
authors.forename: Ross Stewart
authors.initials: RS
authors.lastname: Bailie
keywords: Aboriginal; Australia; Indigenous health services; Torres Strait Islander; best practice; primary health care; quality improvement; quality of care
references.citation: BMC Health Serv Res. 2014 Nov 19;14:578
references.pmid: 25408165
references.citation: Implement Sci. 2010 Mar 13;5:21
references.pmid: 20226066
references.citation: Health Policy Plan. 2012 Aug;27(5):365-73
references.pmid: 21821667
references.citation: Int J Qual Health Care. 2008 Jun;20(3):172-83
references.pmid: 18339666
references.citation: BMC Health Serv Res. 2013 Dec 18;13:525
references.pmid: 24350582
references.citation: Diabetes Metab Res Rev. 2010 Sep;26(6):464-73
references.pmid: 20082409
references.citation: J Public Health Manag Pract. 1998 Mar;4(2):55-65
references.pmid: 10186734
references.citation: BMC Health Serv Res. 2010 May 19;10:129
references.pmid: 20482810
references.citation: Implement Sci. 2013 Oct 08;8:119
references.pmid: 24098940
references.citation: BMJ. 2003 Apr 5;326(7392):759-61
references.pmid: 12676849
references.citation: Implement Sci. 2006 Feb 22;1:2
references.pmid: 16722567
references.citation: Aust J Rural Health. 2011 Jun;19(3):111-7
references.pmid: 21605223
references.citation: Health Serv Res. 2002 Jun;37(3):791-820
references.pmid: 12132606
references.citation: BMC Health Serv Res. 2011 Jun 01;11:139
references.pmid: 21627846
references.citation: Health Aff (Millwood). 2001 Nov-Dec;20(6):64-78
references.pmid: 11816692