Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

Overview

Journal Front Public Health

Specialty Public Health

Date 2018 Apr 7

PMID 29623271

Citations 18

Authors

Janya McCalman

Ross Bailie

Roxanne Bainbridge

Karen McPhail-Bell

Nikki Percival

Deborah Askew

Ruth Fagan

Komla Tsey

Affiliations

Soon will be listed here.

Abstract

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10-20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

Citing Articles

Supporting healthy lifestyles for First Nations women and communities through co-design: lessons and early findings from remote Northern Australia.

Dias T, MacKay D, Canuto K, Boyle J, DAntoine H, Hampton D Front Clin Diabetes Healthc. 2024; 5:1356060.

PMID: 38863516 PMC: 11165116. DOI: 10.3389/fcdhc.2024.1356060.

A mixed-methods descriptive study on the role of continuous quality improvement in rural surgical and obstetrical stability: Considering enablers, challenges and impact.

Kornelsen J, Cameron A, Stoll K, Skinner T, Humber N, Williams K PLoS One. 2024; 19(6):e0300977.

PMID: 38843178 PMC: 11156343. DOI: 10.1371/journal.pone.0300977.

A scoping review of continuous quality improvement in healthcare system: conceptualization, models and tools, barriers and facilitators, and impact.

Endalamaw A, Khatri R, Mengistu T, Erku D, Wolka E, Zewdie A BMC Health Serv Res. 2024; 24(1):487.

PMID: 38641786 PMC: 11031995. DOI: 10.1186/s12913-024-10828-0.

Is a bio-psychosocial approach model possible at the first level of health services in the Democratic Republic of Congo? An organizational analysis of six health centers in South Kivu.

Molima C, Karemere H, Makali S, Bisimwa G, Macq J BMC Health Serv Res. 2023; 23(1):1238.

PMID: 37951897 PMC: 10638814. DOI: 10.1186/s12913-023-10216-0.

Program Report: Improving Patient Experience at an Outpatient Clinic Using Continuous Improvement Tools.

Siddiqui M, Khafagy A, Majeed F Healthcare (Basel). 2023; 11(16).

PMID: 37628499 PMC: 10454562. DOI: 10.3390/healthcare11162301.

References

Matthews V, Schierhout G, McBroom J, Connors C, Kennedy C, Kwedza R . Duration of participation in continuous quality improvement: a key factor explaining improved delivery of Type 2 diabetes services. BMC Health Serv Res. 2014; 14:578. PMC: 4243284. DOI: 10.1186/s12913-014-0578-1. View

Crawford M, Aldridge T, Bhui K, Rutter D, Manley C, Weaver T . User involvement in the planning and delivery of mental health services: a cross-sectional survey of service users and providers. Acta Psychiatr Scand. 2003; 107(6):410-4. DOI: 10.1034/j.1600-0447.2003.00049.x. View

Tricco A, Antony J, Ivers N, Ashoor H, Khan P, Blondal E . Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and meta-analysis. CMAJ. 2014; 186(15):E568-78. PMC: 4203622. DOI: 10.1503/cmaj.140289. View

Langham E, McCalman J, Matthews V, Bainbridge R, Nattabi B, Kinchin I . Social and Emotional Wellbeing Screening for Aboriginal and Torres Strait Islanders within Primary Health Care: A Series of Missed Opportunities?. Front Public Health. 2017; 5:159. PMC: 5500609. DOI: 10.3389/fpubh.2017.00159. View

Prost A, Colbourn T, Seward N, Azad K, Coomarasamy A, Copas A . Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis. Lancet. 2013; 381(9879):1736-46. PMC: 3797417. DOI: 10.1016/S0140-6736(13)60685-6. View

Bailie R, Matthews V, Larkins S, Thompson S, Burgess P, Weeramanthri T . Impact of policy support on uptake of evidence-based continuous quality improvement activities and the quality of care for Indigenous Australians: a comparative case study. BMJ Open. 2017; 7(10):e016626. PMC: 5639983. DOI: 10.1136/bmjopen-2017-016626. View

Spurling G, Bond C, Schluter P, Kirk C, Askew D . 'I'm not sure it paints an honest picture of where my health's at' - identifying community health and research priorities based on health assessments within an Aboriginal and Torres Strait Islander community: a qualitative study. Aust J Prim Health. 2017; 23(6):549-553. DOI: 10.1071/PY16131. View

Kaplan H, Provost L, Froehle C, Margolis P . The Model for Understanding Success in Quality (MUSIQ): building a theory of context in healthcare quality improvement. BMJ Qual Saf. 2011; 21(1):13-20. DOI: 10.1136/bmjqs-2011-000010. View

McCalman J, Bainbridge R, Russo S, Rutherford K, Tsey K, Wenitong M . Psycho-social resilience, vulnerability and suicide prevention: impact evaluation of a mentoring approach to modify suicide risk for remote Indigenous Australian students at boarding school. BMC Public Health. 2016; 16:98. PMC: 4736696. DOI: 10.1186/s12889-016-2762-1. View

10.

Israel B, Schulz A, Parker E, Becker A . Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998; 19:173-202. DOI: 10.1146/annurev.publhealth.19.1.173. View

11.

McDonald E, Bailie R, Morris P . Participatory systems approach to health improvement in Australian Aboriginal children. Health Promot Int. 2017; 32(1):62-72. DOI: 10.1093/heapro/dau003. View

12.

ODonoghue L, Percival N, Laycock A, McCalman J, Tsey K, Armit C . Evaluating Aboriginal and Torres Strait Islander health promotion activities using audit and feedback. Aust J Prim Health. 2014; 20(4):339-44. DOI: 10.1071/PY14048. View

13.

McGinnis J, Williams-Russo P, Knickman J . The case for more active policy attention to health promotion. Health Aff (Millwood). 2002; 21(2):78-93. DOI: 10.1377/hlthaff.21.2.78. View

14.

Woods C, Carlisle K, Larkins S, Thompson S, Tsey K, Matthews V . Exploring Systems That Support Good Clinical Care in Indigenous Primary Health-care Services: A Retrospective Analysis of Longitudinal Systems Assessment Tool Data from High-Improving Services. Front Public Health. 2017; 5:45. PMC: 5364947. DOI: 10.3389/fpubh.2017.00045. View

15.

ONeill S, Hempel S, Lim Y, Danz M, Foy R, Suttorp M . Identifying continuous quality improvement publications: what makes an improvement intervention 'CQI'?. BMJ Qual Saf. 2011; 20(12):1011-9. PMC: 3228263. DOI: 10.1136/bmjqs.2010.050880. View

16.

Percival N, ODonoghue L, Lin V, Tsey K, Bailie R . Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care. Front Public Health. 2016; 4:53. PMC: 4812048. DOI: 10.3389/fpubh.2016.00053. View

17.

McDonald E, Bailie R, Michel T . Development and trialling of a tool to support a systems approach to improve social determinants of health in rural and remote Australian communities: the healthy community assessment tool. Int J Equity Health. 2013; 12:15. PMC: 3598488. DOI: 10.1186/1475-9276-12-15. View

18.

Potter C, Brough R . Systemic capacity building: a hierarchy of needs. Health Policy Plan. 2004; 19(5):336-45. DOI: 10.1093/heapol/czh038. View

19.

Bailie R, Si D, Shannon C, Semmens J, Rowley K, Scrimgeour D . Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples. BMC Health Serv Res. 2010; 10:129. PMC: 2882384. DOI: 10.1186/1472-6963-10-129. View

20.

Bailie R, Si D, ODonoghue L, Dowden M . Indigenous health: effective and sustainable health services through continuous quality improvement. Med J Aust. 2007; 186(10):525-7. DOI: 10.5694/j.1326-5377.2007.tb01028.x. View