ABCD: Audit and Best Practice for Chronic Disease

Project summary

This continuous quality improvement (CQI) project aims to enhance health outcomes by assisting Indigenous primary health care centres to improve their systems for delivery of best practice care. Focused initially on chronic disease, the 12 original participating health care centres in the Top End achieved significant improvements in quality of care and diabetes outcomes for clients. The current extension phase of the project is targeting a wider range of primary health care priorities and incorporating the ABCD approach into routine practice. Project staff work with health centre staff to identify strengths and weaknesses in their systems, set goals for improvement, develop strategies to achieve these goals, and then assess the effectiveness of these strategies.

Summary of outcomes

• There are now more than 70 Indigenous primary health care centres from four states/territories—NT, WA, NSW and north Queensland—formally enrolled in the project. Regional support hubs have been established in these states/territories.
• The project tools are being used in many other Indigenous and non-Indigenous settings across Australia, with interest in using the tools coming from Canada, Fiji and South Africa.
• The project has resulted in improvements in:
  • health centre systems (such as clarification of roles and responsibilities for chronic illness care)
  • delivery of services according to best practice guidelines (such as more regular monitoring of blood pressure and blood glucose)
  • intermediate health outcomes (such as better control of blood glucose and cholesterol)

Summary of project implementation

Long-term research/service/policy partnerships, such as the one established through the CRC for Aboriginal Health, have been critical to the success of the ABCD Project. They were important in developing appropriate quality improvement (QI) processes and tools, achieving engagement of Indigenous primary care services and in demonstrating the benefit of a national resource to support development and implementation of QI systems. There is a need for national resources to coordinate these functions, and QI initiatives in Indigenous primary health care more broadly. The ABCD Project provides a solid foundation for such a resource.

Key findings/messages

• Successful partnerships between state governments, health services and a university have been established to support Aboriginal Health Services in developing CQI processes that improve the quality of systems for delivering clinical best practice. These partnerships provide vital resources and in-kind support that assist Aboriginal Health Services to implement chronic disease policy. Such partnerships should be strengthened and resourced.
• State/territory level chronic disease policies enable jurisdictions to tackle chronic conditions in a more integrated way that encompasses prevention, promotion and management strategies. There is a need for further effective implementation of these policies.
• CQI processes could be further embedded in state and territory health authorities by building CQI processes and responsibilities into business plans and position descriptions.
• Chronic disease multidisciplinary teams require an inter-professional, cross-cultural skills mix that includes educators, clinicians, health promotion and Indigenous staff.
• Aboriginal Health Workers (AHWs) should be more involved in chronic disease care. AHWs’ career pathways need to be developed to include specific roles in chronic disease prevention, early identification and management.
• Uniform reporting frameworks support the implementation of chronic disease programs. Alignment of reporting requirements will support the implementation of system-wide best practice in care, and create efficiencies for services.
• Communication of health data across sectors (between levels of government, between government departments, and between the government, private and Aboriginal community controlled sectors) is limited and is an area for improvement.
• Prevention activity is underdeveloped. With improved coordination between disease specific agencies, non-government organisations (NGOs) should be well placed to contribute to the delivery of prevention programs.
• Core current and future requirements are for:
  • Expansion of the facilitation support network for health centres
  • Maintaining the operation of the web-based information system
  • Development of additional tools for priority aspects of care
  • Continuing R&D to expand the evidence base for both CQI processes in this setting and the outcomes achieved
  • Improvements in all key aspects of systems to support chronic illness care for almost all participating centres
  • Improvement in percentage of scheduled diabetes services
  • Significant health improvements in proportion of people with diabetes controlling HbA1c, BP and cholesterol levels
  • The participatory action approach taken by the project team, and the values and principles underlying this approach was an important factor in the success of the project
  • The CQI process is feasible, acceptable and highly valued within these primary care settings
  • Driving components to improving quality of care included availability of resources, organizational systems and quality of management
  • Best practice medical management and self-management needs to be strengthened to ensure that early diagnosis and good monitoring result in improved health outcomes

The Audit and Best Practice in Chronic Disease (ABCD) research project has led to the establishment of One21seventy, a not-for-profit entity that provides tools, training and support for primary health care centres and providers to use the One21seventy CQI cycle, CQI audit and systems assessment tools, and on-line data services for easy interpretation and reporting. The One21seventy website gives more information about the outcomes of the ABCD project.

Related resources: 

• Schierhout, G., Brands, J. & Bailie, R. 2010, Audit and Best Practice for Chronic Disease Extension Project, 2005–2009: Final Report PDF, The Lowitja Institute, Melbourne.
• Policy Brief: Chronic Illness Care for Indigenous Australians: Implications for Policy from the ABCD Project (2008) 
• Fact Sheet: Quality Improvement in Indigenous Primary Health Care (2008) 
• Bailie, R. S., Si, D., Dowden, M. & Lonergan, K. 2007, Audit and Best Practice for Chronic Disease—Project Final Report, Menzies School of Health Research, Darwin 
• Bailie, R., Si, D., O’Donoghue, L. & Dowden, M. 2007, 'Indigenous Health: The potential and requirements of continuous quality improvement for effective and sustainable services, Med J Aust, vol. 186, issue 10, pp. 525–7.
• Bailie R, Si D, Dowden, M., O’Donoghue, L., Connors, C., Robinson, G., Cunningham, J. & Weeramanthri, T. 2007, 'Improving Organisational Systems for Diabetes Care in Australian Indigenous Communities', BMC Health Serv Res, vol. 7, issue 1, p. 67.
• Si, D., Bailie, R., Dowden, M., O’Donoghue, L., Connors, C., Robinson, G. W., Cunningham, J., Condon, J. R. & Weeramanthri, T. S. 2007, 'Delivery of Preventive Health Services to Indigenous Adults: Response to a systems-oriented primary care quality improvement intervention', Med J Aust, vol. 187, issue 8, pp. 453–7.