1. Structural barriers to improving Aboriginal and Torres Strait Islander health: The ABCD Extension Project

2. ABCD Extension Project Background Original ABCD Project (2002 – 2006) – Examined feasibility and impact of applying modern QI approaches in Indigenous PHC Findings Systematic approach to using audit and system assessment tools is feasible Results in improvement in – Health centre systems – Adherence to best practice guidelines in service delivery – Intermediate health outcomes

3. Wider implementation Additional tools Integrate process into routine activity Research on factors affecting uptake and sustainability of impacts 2005 - 2009 ABCD Extension Project Aims

4. ABCD Extension Project Approach STEP 1: Signed Agreement STEP 2: Training/ Orientation STEP 6: act Implement changes STEP 5: Action Planning Feedback, workshop & goal setting for system changes STEP 4: Participatory Interpretation. Data analysis & report preparation STEP 3: Audits, system assessment Project implemented through regional hubs: Top End Central Australia Far West NSW WA North QLD

5. Participatory Action Research Clinical Audits Systems Assessment Observation by Hub Coordinators  quarterly reports; scoring on key factors; structured dialogue In-depth Interviews (largely focused on two regions – Karen Gardner)  practitioners, health centre managers and staff, policy makers, Hub Coordinators, researchers ABCD Extension Project Research Methods

6. Alignment of ABCD CQI process and major policy initiatives: Healthy for Life Emphasis on chronic disease prevention and management Increasing interest in accountability, accreditation and performance indicators New Medicare items Closing the Gap campaign and funding Structural facilitators for implementation of CQI (1)

7. System level support for implementation Information systems Management culture and leadership Dedicated coordinator / facilitator support Staff stability, staffing levels Medical staff - culture and role Structural facilitators for implementation of CQI (2)

8. ABCDE Project provided some structural support: Technical support (website, helpdesk) Training in CQI methods Hub coordinators provided on site support, built local capacity External facilitators support momentum Regular update of evidence-based tools Measures to support structural facilitators for CQI

9. Significant achievements despite barriers Structural factors enhance or limit potential of teams and individuals to provide good quality care Innovative opportunities to strengthen structural facilitators and overcome structural barriers to implementation of CQI Key summary points