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Assessing health centre systems for guiding improvement in diabetes care

Si, Damin, Bailie, Ross S., Connors, Christine M., Dowden, Michelle, Stewart, Allison, Robinson, Gary W., Cunningham, Joan and Weeramanthri, Tarun S. (2005). Assessing health centre systems for guiding improvement in diabetes care. BMC Health Services Research,5(1):56-64.

Document type: Journal Article
Citation counts: Scopus Citation Count Cited 21 times in Scopus Article | Citations

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Title Assessing health centre systems for guiding improvement in diabetes care
Author Si, Damin
Bailie, Ross S.
Connors, Christine M.
Dowden, Michelle
Stewart, Allison
Robinson, Gary W.
Cunningham, Joan
Weeramanthri, Tarun S.
Journal Name BMC Health Services Research
Publication Date 2005
Volume Number 5
Issue Number 1
ISSN 14726963   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-24944517041
Start Page 56
End Page 64
Total Pages 9
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
Abstract Background: Aboriginal people in Australia experience the highest prevalence of diabetes in the country, an excess of preventable complications and early death. There is increasing evidence demonstrating the importance of healthcare systems for improvement of chronic illness care. The aims of this study were to assess the status of systems for chronic illness care in Aboriginal community health centres, and to explore whether more developed systems were associated with better quality of diabetes care.

Methods: This cross-sectional study was conducted in 12 Aboriginal community health centres in the Northern Territory of Australia. Assessment of Chronic Illness Care scale was adapted to measure system development in health centres, and administered by interview with health centre staff and managers. Based on a random sample of 295 clinical records from attending clients with diagnosed type 2 diabetes, processes of diabetes care were measured by rating of health service delivery against best-practice guidelines. Intermediate outcomes included the control of HbA1c, blood pressure, and total cholesterol.

Results: Health centre systems were in the low to mid-range of development and had distinct areas of strength and weakness. Four of the six system components were independently associated with quality of diabetes care: an increase of 1 unit of score for organisational influence, community linkages, and clinical information systems, respectively, was associated with 4.3%, 3.8%, and 4.5% improvement in adherence to process standards; likewise, organisational influence, delivery system design and clinical information systems were related to control of HbA1c, blood pressure, and total cholesterol.

Conclusion: The state of development of health centre systems is reflected in quality of care outcome measures for patients. The health centre systems assessment tool should be useful in assessing and guiding development of systems for improvement of diabetes care in similar settings in Australia and internationally.
Keywords Indigenous Ausralians
health centre systems
diabetes care
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