1. Improving Services to Aboriginal and Torres Strait Islander Peoples: The ABCD Extension Project

2. Poor health outcomes Lack of consistent measures of quality of care Impact of interventions is often not sustained Modern CQI as a potential strategy in PHC Background to the ABCD Extension Project (1)

3. Background to the ABCD Extension Project (2) 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

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

5. ABCD Extension Project: Approach STEP 1: Signed Agreement STEP 2: Training/ Orientation STEP 6: act Implement changes STEP 5: Action Planning. Clinic 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

6. MELBOURNE DARWIN BRISBANE HOBART SYDNEY CANBERRA ADELAIDE PERTH ABCD Site ABCD associated sites ABCD tools only

7. 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)  practitioners, health centre managers and staff, policy makers, Hub Coordinators, researchers Research Methods

8. Trends for overall delivery of preventive services: All services with 3+ rounds of audit data

9. Preliminary findings from preventive services audits 36 services which completed three rounds of audits (n = 1024-1129 client records BaselineRound 3 audit Change: Baseline to round 3 Overall adherence 31%44%13% (p<0.01) BP check in last year 65%74%11% (p=0.07) Follow up of abnormal BP 19%37%18% (p<0.01) Follow up of proteinuria 22%63%41% (p<0.01)

10. Trends for overall delivery of preventive services: Selected services with 3+ rounds of audit data

11. Preliminary findings: Key factors explaining improvement in preventive services Leadership for QI (Medical and Management) Population health approach Regional level support systems Involvement of AHWs in preventive care

12. Complete analysis ABCD Extension Project Final Report Other dissemination Integrate lessons into One21seventy service support ABCD Research Partnership  Improving practice through research What next?