Continuous quality improvement and metabolic screening during pregnancy at primary health centres attended by Aboriginal and Torres Strait Islander women.

ABSTRACT

OBJECTIVE: To investigate associations between the provision of routine metabolic screening and follow-up in pregnancy and participation by primary health care centres in a large-scale continuous quality improvement (CQI) initiative. DESIGN: Longitudinal analysis of 2592 audited maternal health records. SETTING AND PARTICIPANTS: Seventy-six community-controlled or government-operated primary health care centres serving predominantly Aboriginal and Torres Strait Islander communities, in urban, regional or remote locations in five Australian states and territories. INTERVENTION Up to four CQI cycles supported by the Audit and Best Practice for Chronic Disease Research Partnership. MAIN OUTCOMES MEASURES: Screening and follow-up for body mass index (BMI), blood pressure and diabetes in pregnancy. RESULTS: Overall, 87.9% of women attending the participating health centres were Aboriginal or Torres Strait Islander. Women attending a health centre after it had conducted one or more CQI cycles were more likely to receive BMI, blood pressure and diabetes screening. For example, the proportion of women receiving diabetes screening at baseline (before the first CQI cycle) was 56.1%; after cycle 1 it was 63.7% (odds ratio [OR], 1.3; 95% CI, 1.0-1.6), after cycle 2, 61.6% (OR, 1.2; 95% CI, 0.9-1.7), after cycle 3, 63.7% (OR, 1.7; 95% CI, 1.1-2.6), and after cycle 4, 75.5% (OR, 3.4; 95% CI, 1.9-5.9). Diabetes screening was associated with higher self-ratings of overall organisational systems (P = 0.03), self-management support (P = 0.04) and organisational influence and integration (P = 0.01). CONCLUSION: These findings support the value of CQI approaches that focus on systems-level issues in primary care to improve the provision of recommended pregnancy care at primary health care centres in predominantly Aboriginal and Torres Strait Islander communities.