Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services
Diabetes is a major health problem in Australia, particularly for Aboriginal people. Good diabetes health care can prevent the development of complications from diabetes and improve quality of life.
Caring for diabetes involves a healthy lifestyle (eating well and exercising regularly); treatment with medications that control sugar levels and other risk factors; and regular screening for the presence of diabetes complications.
Through a quality improvement intervention, we wanted to see how well patients with diabetes were being cared for at four ACCHSs in the Kimberley, and to identify strategies for improvement. We also wanted to evaluate the continuous quality improvement (CQI) cycle and identify strategies to improve the way this is conducted in Kimberley ACCHSs into the future.
This study described the service characteristics of DAHS (which was part of a long term CQI project) and three other Kimberley ACCHS. We also documented diabetes management activities and intermediate clinical outcomes for Aboriginal patients with type 2 diabetes. During interviews with staff and focus groups with patients we discussed the audit results and strategies that could improve diabetes care.
- Blood and urine tests that are recommended to be done yearly were done for most patients at three of the four ACCHS. Other care processes such as foot checks and eye checks were not done as frequently as urine and blood tests.
- Care processes such as blood pressure, weight and waist measurement, HbA1c testing, and assessment of lifestyle were done in most patients at least once in the year, but not many patients had these tests done as frequently as recommended (every 6 months).
- Measurements of patient health status tended to be better at DAHS where there has been over ten years of CQI in diabetes care.
Suggestions identified by staff and patients for improving care:
- Improving the computer based patient information system to make it easier for staff members when conducting diabetes care.
- Improving the function of the multidisciplinary health care team and clarifying role descriptions.
- There was particular emphasis on supporting an increased involvement of Aboriginal health workers in diabetes care delivery as they were seen as playing a very important role.
- A need for increased staffing was identified at some of the health services.
Suggested strategies for improving the way that CQI is conducted in Kimberley ACCHSs:
- Changes to the computer based patient information system to improve the accuracy of future audits, increase tracking of patients as they move between communities in the region, and improve ease-of-use.
- Allocation of staffing resources where needed and clearer description of roles for chronic disease management programs.
- Development of a role for a KAMSC regional quality improvement facilitator to assist ACCHSs with their quality improvement efforts.
Well-designed health care delivery and CQI systems, with a strong sense of ownership over diabetes management can increase service delivery rates and improve clinical outcome measures in ACCHSs. Locally run CQI processes may be more responsive to individual health services and more sustainable than externally driven systems
Alice C Stoneman, David Atkinson, Maureen Davey and Julia V Marley. Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services. BMC Health Services Research 2014;14:481.