title: Developing community-driven quality improvement initiatives to enhance chronic disease care in Indigenous communities in Canada: the FORGE AHEAD program protocol.
abstract: BACKGROUND
  Given the dramatic rise and impact of chronic diseases and gaps in care in Indigenous peoples in Canada, a shift from the dominant episodic and responsive healthcare model most common in First Nations communities to one that places emphasis on proactive prevention and chronic disease management is urgently needed.
  
  
  METHODS
  The Transformation of Indigenous Primary Healthcare Delivery (FORGE AHEAD) Program partners with 11 First Nations communities across six provinces in Canada to develop and evaluate community-driven quality improvement (QI) initiatives to enhance chronic disease care. FORGE AHEAD is a 5-year research program (2013-2017) that utilizes a pre-post mixed-methods observational design rooted in participatory research principles to work with communities in developing culturally relevant innovations and improved access to available services. This intensive program incorporates a series of 10 inter-related and progressive program activities designed to foster community-driven initiatives with type 2 diabetes mellitus as the action disease. Preparatory activities include a national community profile survey, best practice and policy literature review, and readiness tool development. Community-level intervention activities include community and clinical readiness consultations, development of a diabetes registry and surveillance system, and QI activities. With a focus on capacity building, all community-level activities are driven by trained community members who champion QI initiatives in their community. Program wrap-up activities include readiness tool validation, cost-analysis and process evaluation. In collaboration with Health Canada and the Aboriginal Diabetes Initiative, scale-up toolkits will be developed in order to build on lessons-learned, tools and methods, and to fuel sustainability and spread of successful innovations.
  
  
  CONCLUSIONS
  The outcomes of this research program, its related cost and the subsequent policy recommendations, will have the potential to significantly affect future policy decisions pertaining to chronic disease care in First Nations communities in Canada.
  
  
  BACKGROUND
  Current ClinicalTrial.gov protocol ID NCT02234973 . Date of Registration: July 30, 2014.
authors.affiliation: Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1511 Richmond Street, London, Ontario, N6K 3K7, Canada. mariam.naqshbandi-hayward@schulich.uwo.ca.
authors.forename: Mariam
authors.initials: M
authors.lastname: Naqshbandi Hayward
authors.affiliation: Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1511 Richmond Street, London, Ontario, N6K 3K7, Canada.
authors.forename: Jann
authors.initials: J
authors.lastname: Paquette-Warren
authors.affiliation: Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1511 Richmond Street, London, Ontario, N6K 3K7, Canada.
authors.forename: Stewart B
authors.initials: SB
authors.lastname: Harris
mesh_terms: D002170:Canada; D002908:Chronic Disease / Q000628:therapy*; D003256:Community Participation; D054521:Cultural Competency; D003695:Delivery of Health Care / Q000592:standards; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D006291:Health Policy; D006297:Health Services Accessibility; D006302:Health Services Research; D006303:Health Services, Indigenous / Q000592:standards*; D006801:Humans; D007198:Indians, North American; D058996:Quality Improvement; D012111:Residence Characteristics
keywords: Chronic disease; Complex interventions; Diabetes; First Nations; Indigenous; Quality improvement