Reorienting primary health care for addressing chronic conditions in remote Australia and the South Pacific: Review of evidence and lessons from an innovative quality improvement process

• Published in: The Australian journal of rural health 2011-06, Vol.19 (3), p.111-117
• Main Authors: Gardner, Karen, Bailie, Ross, Si, Damin, O'Donoghue, Lynette, Kennedy, Cath, Liddle, Helen, Cox, Rhonda, Kwedza, Ru, Fittock, Marea, Hains, Jenny, Dowden, Michelle, Connors, Christine, Burke, Hugh, Beaver, Carol
• Format: Article
• Language: English
• Subjects: Action research; Australia; Best practice; Change agents; Chronic conditions; Chronic Disease; Chronic illnesses; Chronic sickness; Clinical outcomes; Colonies & territories; Community-Based Participatory Research; Continuity of Patient Care - standards; Continuous quality improvement; Data processing; Diabetes; Diabetes mellitus; Diabetes Mellitus - therapy; Diffusion of Innovation; Evidence-Based Practice; Health care; Health Services, Indigenous - standards; Humans; Innovations; Knowledge base; Knowledge bases (artificial intelligence); Literature reviews; Nursing; Outcome and Process Assessment (Health Care); Pacific Islands; Participatory action research; Patients; plan-do-study-act; Primary care; primary health care; Professional knowledge; Quality control; Quality Improvement; Quality Indicators, Health Care; Quality management; Quality of care; Remote areas; Service provision; Social services delivery; Total Quality Management - organization & administration; Training; Translation
• ISSN: 1038-5282; 1440-1584
• DOI: 10.1111/j.1440-1584.2010.01181.x

This paper reviews what is known about the challenges of implementing quality improvement programs and draws on data from a systematic continuous quality improvement (CQI) project in remote communities in Australia and Fiji, known as Audit and Best practice for Chronic Disease, to synthesise lessons and discuss the potential for broader application in low and middle income countries, including Pacific Island countries and territories. Although a number of systematic reviews have indicated that quality improvement programs can be effective in changing professional practice and improving the quality of care and patient outcomes, little is known about the key ingredients for change or how services use and implement different strategies to achieve improvements. We identify key features of an innovative CQI model and factors related to implementation that support improvement in diabetes service delivery and intermediate outcomes. Requirements for supporting CQI are identified and the potential for wider application discussed. It is argued that the participatory action research approach supports innovation and broad‐based change and the evidence it has produced extends the current knowledge base and facilitates the translation of knowledge into action, for both policy and practice.