More about CQI and Indigenous primary health care
The One21seventy CQI cycle was developed in the Audit and Best Practice for Chronic Disease (ABCD) project. One21seventy itself carries on the work of the ABCD Project in supporting the use of continuous quality improvement (CQI) in Indigenous primary health care. The ABCD Project began in 2002 and ended in 2009. It was a CQI project to improve health outcomes by assisting health services to improve their systems for delivery of best practice care. It used an action-research approach to work with health centre staff to identify strengths and weaknesses in their systems, set goals for improvement, develop strategies to achieve these goals, and assess the effectiveness of these strategies in improving chronic illness care. It initially involved three cycles of assessment, feedback, planning and implementation in 12 health centres in the Top End of the Northern Territory; by 2009, 120 health centres were using ABCD tools and processes across Australia. The ABCD Project demonstrated that a CQI model could be both attractive to, and effective in, supporting Indigenous primary health care centres to use evidence-based good practice in chronic illness care. Initial analysis of data of health centre performance over time shows that the majority of health centres in the project improved their performance in relation to most indicators, with some centres making extraordinary improvements. The ABCD Project has also influenced national, state and territory policy and programs in relation to Indigenous primary health care. The Healthy for Life Program was influenced by the ABCD Project. Healthy for Life began as a $102 million program that encourages the use of continuous quality improvement cycles for the delivery of health care programs by Indigenous health services, and which is now funded on an ongoing basis. The ABCD project influenced the design of this program, including the role of facilitation support for health services using the program, and has directly contributed to audit and system assessment tools. CQI is being incorporated into core Indigenous health programs in a number of states and territories.
What others say
A study of the impact of primary health care research, carried out by the Primary Health Care Research and Information Services (PHCRIS), found the ABCD project notable amongst those they examined for the extent of its influence on policy and practice and as the only project to have demonstrated improvements in health outcomes. To read more about this study, click here.
The Lowitja Institute: Australia's National Institute for Aboriginal and Torres Strait Islander Health Research, and formally the Cooperative Research Centre for Aboriginal Health (CRCAH), which funded part of the project, sees ABCD as one of its most successful projects in translating research into policy and practice. In early 2009, the CRCAH commissioned Access Economics to carry out a prospective economic evaluation of its proposed research. Using published data from the ABCD project and other sources, Access Economics estimated that on a forward projection of 15 years, the potential economic value of the health gain from a 4.6% improvement in Indigenous diabetes management (well within that achieved within the ABCD project) would be $746.2 million (in Disability Adjusted Life Years saved). In addition, there would be an associated $705.1 million in financial savings from workplace productivity and other resources saved. Of this, $345.5 million could be attributed to the impact of the research.
Continuous quality improvement (CQI) originated in the manufacturing sector, and became an international movement through the work of Dr W. Edwards Deming who helped revolutionise Japanese industry following World War 2 .
CQI was taken up in United States hospitals in the late 1980s, and is now increasingly being used in other health care settings.
In health care, CQI is defined as ‘a structured organisational process for involving personnel in planning and executing a continuous stream of improvements in systems in order to provide quality health care that meets or exceeds customer expectations’ .
For more information about CQI and quality of care, click here.
References:
- Best, M., and Neuhauser, D. 2005, W. Edwards Deming: Father of quality management, patient and composer. Qual Saf Health Care. 2005 August; 14(4): 310–312.doi: 10.1136/qshc.2005.015289.
- Luce, J.M., Bindman, A.B., and Lee, P.R. 1994 A brief history of health care quality assessment and improvement in the United States, West J Med. 1994 March; 160(3): 263–268.
- McLaughlin, C., & Kaluzny, A. (1994). Continuous quality improvement in health care: theory, implementation, and applications. Gaithersburg: An Aspen Publication.
A critical element of CQI in health care is the process of systems assessment.
The McColl Institute in the USA developed a tool for assessment of organisational systems relevant to chronic illness care: the Assessment of Chronic Illness Care (ACIC) scale based on the Chronic Care Model developed by the same group.
The Chronic Care Model identified six system elements of a primary health care organisation that should support high-quality chronic illness care.
The Chronic Care Model has been the subject of wide international attention and has formed the basis of a World Health Organisation (WHO) framework for Innovative Care of Chronic Conditions (ICCC Framework)
The ICCC framework includes attention to the broader policy environment: legislation, financial arrangements for service provision, governance, relationships and collaborations, governmental support, workforce education, etc.
The Systems Assessment Tool used by One21seventy was developed as part of the ABCD project, drawing on the McColl Institute’s ACIC model and the WHO’s ICCC Framework, which was found to be highly relevant to the Australian Indigenous primary care environment.
For more information about systems assessment in health care, click here.
The Indigenous primary health care sector is leading the way in the adoption of Continuous Quality Improvement (CQI) in primary health care in Australia.
Indigenous primary health care providers have been involved in CQI programs and projects such as the Australian Primary Care Collaboratives, the Continuous Improvement Projects, Healthy for Life and the Audit and Best Practice for Chronic Disease (ABCD) project.
The interest in – and effectiveness of – quality improvement as a tool in the effort to Close the Gap has led to the establishment of One21seventy, Australia’s only organization set up specifically to support CQI in Indigenous primary health care.
For further reading about CQI and Indigenous health, click here.