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Duration of participation in continuous quality improvement: a key factor explaining improved delivery of Type 2 diabetes services

Matthews, Veronica, Schierhout, Gillian, McBroom, James, Connors, Christine M., Kennedy, Catherine, Kwedza, Ru, Larkins, Sarah, Moore, Elizabeth, Thompson, Sandra, Scrimgeour, David and Bailie, Ross S. (2014). Duration of participation in continuous quality improvement: a key factor explaining improved delivery of Type 2 diabetes services. BMC Health Services Research,14(Article No. 578).

Document type: Journal Article
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ARC Grant No. FT100100087
IRMA ID 84473293xPUB9
NHMRC Grant No. 545267
Title Duration of participation in continuous quality improvement: a key factor explaining improved delivery of Type 2 diabetes services
Author Matthews, Veronica
Schierhout, Gillian
McBroom, James
Connors, Christine M.
Kennedy, Catherine
Kwedza, Ru
Larkins, Sarah
Moore, Elizabeth
Thompson, Sandra
Scrimgeour, David
Bailie, Ross S.
Journal Name BMC Health Services Research
Publication Date 2014
Volume Number 14
Issue Number Article No. 578
ISSN 1472-6963   (check CDU catalogue open catalogue search in new window)
Total Pages 12
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
It is generally recognised that continuous quality improvement (CQI) programs support development of high quality primary health care systems. However, there is limited evidence demonstrating their system-wide effectiveness. We examined variation in quality of Type 2 diabetes service delivery in over 100 Aboriginal and Torres Strait Islander primary health care centres participating in a wide-scale CQI project over the past decade, and determined the influence of health centre and patient level factors on quality of care, with specific attention to health centre duration of participation in a CQI program.


We analysed over 10,000 clinical audit records to assess quality of Type 2 diabetes care of patients in 132 Aboriginal and Torres Strait Islander community health centres in five states/territories participating in the ABCD project for varying periods between 2005 and 2012. Process indicators of quality of care for each patient were calculated by determining the proportion of recommended guideline scheduled services that were documented as delivered. Multilevel regression models were used to quantify the amount of variation in Type 2 diabetes service delivery attributable to health centre or patient level factors and to identify those factors associated with greater adherence to best practice guidelines.


Health centre factors that were independently associated with adherence to best practice guidelines included longer participation in the CQI program, remoteness of health centres, and regularity of client attendance. Significantly associated patient level variables included greater age, and number of co-morbidities and disease complications. Health centre factors explained 37% of the differences in level of service delivery between jurisdictions with patient factors explaining only a further 1%.


At the health centre level, Type 2 diabetes service delivery could be improved through long term commitment to CQI, encouraging regular attendance (for example, through patient reminder systems) and improved recording and coordination of patient care in the complex service provider environments that are characteristic of non-remote areas.

Keywords Quality improvement
Aboriginal & Torres Strait Islander populations
Type 2 diabetes mellitus
Primary health care
Variation in care
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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

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