title: Remote links: Redesigning maternity care for Aboriginal women from remote communities in Northern Australia - A comparative cohort study.
abstract: OBJECTIVE
  to compare the quality of care before and after the introduction of the new Midwifery Group Practice.
  
  
  METHODS
  a cohort study.
  
  
  METHODS
  the health centers (HCs) in two of the largest remote Aboriginal communities (population 2200-2600) in the Top End of the Northern Territory (NT), each located approximately 500km from Darwin. The third study site was the Royal Darwin Hospital (RDH) which provides tertiary care.
  
  
  METHODS
  a 2004-06 retrospective cohort (n=412 maternity cases) provided baseline data. A clinical redesign of maternity services occurring from 2009 onwards focused on increasing Continuity of Carer, Communication, Choice, Collaboration and Co-ordination of Care (5Cs). Data from a 2009-11 prospective cohort (n=310 maternity cases) were collected to evaluate the service redesign. Outcome measures included indicators on the quality of care delivery, adherence to recommended antenatal guidelines and maternal and neonatal health outcomes.
  
  
  RESULTS
  statistically significant improvements were recorded in many areas reflecting improved access to, and quality of, care. For example: fewer women had <4 visits in pregnancy (14% versus 8%), a higher proportion of women had routine antenatal tests recorded (86% versus 97%) and improved screening rates for urine (82% versus 87%) and sexual tract infections (78% versus 93%). However, the treatment of conditions according to recommended guidelines worsened significantly in some areas; for example antibiotics prescribed for urine infections (86% versus 52%) and treatment for anaemia in pregnancy (77% versus 67%). High preterm (21% versus 20%), low birth weight (18% versus 20%) and PPH (29% versus 31%) rates did not change over time. The out of hospital birth rate remained high and unchanged in both cohorts (10% versus 10%).
  
  
  CONCLUSIONS
  this model addresses some of the disparities in care for remote-dwelling Aboriginal women. However, much work still needs to occur before maternity care and outcomes are equal to that of non-Aboriginal women. Targeted program interventions with stronger clinical governance frameworks to improve the quality of care are essential. A complete rethink of service delivery and engagement may deliver better results.
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Queensland (UQ), Brisbane 4010, Australia; Mater Research Institute-UQ, Brisbane 4010, Australia. Electronic address: sue.kildea@mater.uq.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kildea
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Queensland (UQ), Brisbane 4010, Australia; Mater Research Institute-UQ, Brisbane 4010, Australia. Electronic address: yu.gao@mater.uq.edu.au.
authors.forename: Yu
authors.initials: Y
authors.lastname: Gao
authors.affiliation: University Centre for Rural Health, University of Sydney, Lismore 2480, Australia. Electronic address: margaret.rolfe@ucrh.edu.au.
authors.forename: Margaret
authors.initials: M
authors.lastname: Rolfe
authors.affiliation: School of Health, Charles Darwin University, Darwin 0909, Australia; University Centre for Rural Health, University of Sydney, Lismore 2480, Australia. Electronic address: cath.josif@ucrh.edu.au.
authors.forename: Cathryn M
authors.initials: CM
authors.lastname: Josif
authors.affiliation: University Centre for Rural Health, University of Sydney, Lismore 2480, Australia; Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool L3 5AQ, United Kingdom. Electronic address: Sarah.Bar-Zeev@lstmed.ac.uk.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Bar-Zeev
authors.affiliation: Torrens Resilience Institute, Flinders University, Adelaide 5001, Australia. Electronic address: malinda.steenkamp@flinders.edu.au.
authors.forename: Malinda
authors.initials: M
authors.lastname: Steenkamp
authors.affiliation: School of Nursing, Midwifery and Social Work, The University of Queensland (UQ), Brisbane 4010, Australia; Institute for Urban Indigenous Health, Brisbane 4006, Australia. Electronic address: sue.kruske@uq.edu.au.
authors.forename: Sue
authors.initials: S
authors.lastname: Kruske
authors.affiliation: Darwin Midwifery Group Practice, Darwin 0909, Australia. Electronic address: desley.williams@nt.gov.au.
authors.forename: Desley
authors.initials: D
authors.lastname: Williams
authors.affiliation: Faculty of Health Science, The University of Adelaide, Adelaide 5005, Australia. Electronic address: terry.dunbar@adelaide.edu.au.
authors.forename: Terry
authors.initials: T
authors.lastname: Dunbar
authors.affiliation: University Centre for Rural Health, University of Sydney, Lismore 2480, Australia. Electronic address: Lesley.barclay@sydney.edu.au.
authors.forename: Lesley M
authors.initials: LM
authors.lastname: Barclay
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000592:standards*; D008507:Medically Underserved Area; D008880:Midwifery / Q000592:standards*; D016294:Models, Nursing; D015876:Northern Territory; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D055815:Young Adult
keywords: Aboriginal; Australian; Birth; Indigenous; Midwifery group practice; Remote