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Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre-based continuous quality improvement approach

Ralph, Anna P., Fittock, Marea, Schultz, Rosalie, Thompson, Dale, Dowden, Michelle, Clemens, Tom, Parnaby, Matthew G., Clark, Michele, McDonald, Malcolm I., Edwards, Keith N., Carapetis, Jonathan R. and Bailie, Ross S. (2013). Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre-based continuous quality improvement approach. BMC Health Services Research,13(1):1-13.

Document type: Journal Article
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ARC Grant No. FT100100087
IRMA ID 75039815xPUB478
NHMRC Grant No. 1016567
Title Improvement in rheumatic fever and rheumatic heart disease management and prevention using a health centre-based continuous quality improvement approach
Author Ralph, Anna P.
Fittock, Marea
Schultz, Rosalie
Thompson, Dale
Dowden, Michelle
Clemens, Tom
Parnaby, Matthew G.
Clark, Michele
McDonald, Malcolm I.
Edwards, Keith N.
Carapetis, Jonathan R.
Bailie, Ross S.
Journal Name BMC Health Services Research
Publication Date 2013
Volume Number 13
Issue Number 1
eISSN 1472-6963
Scopus ID 2-s2.0-84890321515
Start Page 1
End Page 13
Total Pages 13
Place of Publication United Kingdom
Publisher BioMed Central
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
Rheumatic heart disease (RHD) remains a major health concern for Aboriginal Australians. A key component of RHD control is prevention of recurrent acute rheumatic fever (ARF) using long-term secondary prophylaxis with intramuscular benzathine penicillin (BPG). This is the most important and cost-effective step in RHD control. However, there are significant challenges to effective implementation of secondary prophylaxis programs. This project aimed to increase understanding and improve quality of RHD care through development and implementation of a continuous quality improvement (CQI) strategy.

Methods
We used a CQI strategy to promote implementation of national best-practice ARF/RHD management guidelines at primary health care level in Indigenous communities of the Northern Territory (NT), Australia, 2008–2010. Participatory action research methods were employed to identify system barriers to delivery of high quality care. This entailed facilitated discussion with primary care staff aided by a system assessment tool (SAT). Participants were encouraged to develop and implement strategies to overcome identified barriers, including better record-keeping, triage systems and strategies for patient follow-up. To assess performance, clinical records were audited at baseline, then annually for two years. Key performance indicators included proportion of people receiving adequate secondary prophylaxis (≥80% of scheduled 4-weekly penicillin injections) and quality of documentation.

Results

Six health centres participated, servicing approximately 154 people with ARF/RHD. Improvements occurred in indicators of service delivery including proportion of people receiving ≥40% of their scheduled BPG (increasing from 81/116 [70%] at baseline to 84/103 [82%] in year three, p = 0.04), proportion of people reviewed by a doctor within the past two years (112/154 [73%] and 134/156 [86%], p = 0.003), and proportion of people who received influenza vaccination (57/154 [37%] to 86/156 [55%], p = 0.001). However, the proportion receiving ≥80% of scheduled BPG did not change. Documentation in medical files improved: ARF episode documentation increased from 31/55 (56%) to 50/62 (81%) (p = 0.004), and RHD risk category documentation from 87/154 (56%) to 103/145 (76%) (p < 0.001). Large differences in performance were noted between health centres, reflected to some extent in SAT scores.

Conclusions
A CQI process using a systems approach and participatory action research methodology can significantly improve delivery of ARF/RHD care.
Keywords Continuous quality improvement
Rheumatic fever
Rheumatic heart disease
Secondary prophylaxis
DOI http://dx.doi.org/10.1186/1472-6963-13-525   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Open access True
Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License 2.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description for Link Link to CC Attribution 2.0 License
URL https://creativecommons.org/licenses/by/2.0/


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