To develop, trial, and evaluate a tool to improve quality, performance measurement, sustainability, and integration of primary health care.
To investigate the quality, governance, and sustainability of a share-care maternity record delivered within an e-health framework across the continuum.
The past decade has seen an increase in focus on quality and safety in primary health care. The Australian National Health Performance Framework (2001) identifies and describes nine quality dimensions and the National Health and Hospitals Reform Commission Final Report (2009) makes recommendations on continuous learning, monitoring, inter-professional and inter-sectoral collaboration. The National Primary Care Strategy (2009) identifies specific priorities relating to improving quality, safety, and accountability.
Extensive work has been undertaken in the design and implementation of quality improvement tools and frameworks in tertiary care settings. Relatively few tools have been designed for, and rigorously trialed within primary health care. In addition, there is a lack of a systematic approach to quality improvement in primary care with the majority of work focusing on single-strategy approaches such as audit, professional education and the development of patient safety and risk management.
Our research will bring together a range of partners, namely: the Royal Australian College of General Practitioners (RACGP); Australian Commission on Safety and Quality in Health Care (ACSQHC); Australian General Practice of Accreditation Limited (AGPAL); Australian Association of Practice Managers Association (AAPM); Australian Practice Nurses Association (APNA); Chronic Illness Alliance; Primary Care Committee; the Improvement Foundation Australia (IFA); and the Federal Department of Health and Ageing (DoHA) in order to:
Develop a new primary care assessment tool for use in improving the quality integration and sustainability of primary health care; and to
Trial and evaluate the new tool in Australian primary health care settings.
National access to best practice maternity care is a key Australian priority (1-6), yet the fragmentation of providers in the sector is a current source of government concern. In particular, maternity care for Aboriginal and Torres Strait Islander women has been highlighted as an area where improved service delivery could contribute to the Closing the Gap national agenda (7,8). Our work will unite influential stakeholders in the research, e-health and policy sectors to trial and evaluate a national evidence-based, web-enabled maternity e-record to safely and effectively integrate clinical care between midwives, GPs, obstetricians, allied health professionals and the woman herself. The Mater Health Services (MHS), in partnership with its general practice community, is currently involved in the ongoing development of national best practice antenatal share-care. The ‘Mater Doctor Portal’ is an e-portal which provides a secure electronic mechanism for a single web-based record for all clinical providers of care. The proposed Personally Controlled Electronic Health Record (PCEHR) is to develop the currently paper bases maternity Patient Hand Held Record (PHHR) into an electronic format controlled by the woman with data shared with all providers of care. Our intervention will bring together the Mater clinical and e-health teams with researchers and national stakeholders of repute in maternity care, e-health and organisational governance to answer three key questions:
In addition to the Chief Investigators Prof Jackson, A/Prof Johnson, Nicholson, Dr Wilkinson, and Associate Investigator Dr Janamian:
Prof Jeremy Oats, Co-Chair, Expert Advisory Committee writing the National Evidence Based Antenatal Care Guidelines, Medical Co-Director Northern Territory Integrated Maternity Service, and worked previously with CI Jackson, developing a multidisciplinary state-wide maternity record prototype.
Prof Sue Kildea, Professor of Midwifery, Division of Women’s Health and Newborn Services, MMH and ACU with particular interest in Indigenous maternity care
Professor Fiona Bogossian, UQ School of Nursing, was midwifery academic for the Ministerial Services Review Steering Committee.
Dr Mukesh Haikerwal is National e-Health Transition Authority (NEHTA) Clinical Lead, and Former Commissioner, National Health & Hospitals Reform Commission.
Prof Malcolm Thatcher (QUT), Chief Information Officer, Mater Health Services, representative of the private hospital sector on the NEHTA Stakeholder Reference Forum, member of Cisco’s Global Health Innovation Council, and former member of the e-Health Ministerial Advisory Group to the Hon. Tony Abbott.
Prof David McIntyre, Head of UQ Mater Clinical School and Director of Endocrinology and Obstetric Medicine at MMH, and an international authority on gestational diabetes.
Dr Wendy Burton, Chair of GP/MMH Maternity Shared Care Alignment, Co-Chair QH Maternity Sharecare Guideline Working Group, and member Statewide Maternity and Neonatal Clinical Network Steering Committee
Dr Don Cave, Director, Perinatal Medicine and Women’s Health Services, MMH.
Prof Trish Greenhalgh, Professor of Primary Health Care (London), has taken a lead role in the evaluation of the multibillion £ NHS ‘Connecting for Health’ program in the UK
Prof John Prins, Director CEO and Institute Director, Mater Medical Research Institute
This study has two aims:(i) to develop a tool to improve quality, performance measurement, sustainability and integration in primary health care in Australia and (ii) to trial and evaluate this new tool in a range of Australian primary health care settings.
Phase 1 incorporates a broad literature review to identify elements included in and missing from a range of quality improvement tools used nationally and internationally. It also incudes a general practice case study using an existing improvement tool. The results from Phase 1 will be used to inform the development of a new quality improvement tool.
Phase 2 will pilot the new tool with 6 general practices in Queensland to determine the process and content validity of the new tool and will include both qualitative interviews with all practice staff and quantitative data from completed tools. The final stage will incorporate the trial of the finalised quality assessment tool with 140 general practices to determine construct validity.
A primary care assessment tool for use in improving quality, performance measurement, sustainability, and integration in primary health care.
This new tool will be a potentially fast, simple, and effective approach to facilitate quality improvement and integration of care in the Australian primary care settings nationwide.
To investigate if using a maternity electronic health record (EHR) improves the quality of data, experiences and integration of care in a general practitioner (GP) share-care model.
The study is using a multi methods approach:
Quanitative data is being collected in two phases: using a paper hand held record (PHR) and using an EHR.
Qualitative data is using a naturalistic or " discovery orientated approach" to map the use of the PHR anfd the introduction of the EHR
Evidence based best practice variables data have been extracted from a maternity record database and analysed for completeness.
a) satisfaction, ease of use and access, perceptions of use b) integration of care (making referrals, communication with other providers, managing documentation).
The evaluation of the PHR and EHR will provide informative data to compare and examine an e-record for accuracy and effective integration of care between women and clinicians. Understanding the experiences of the users is essential to successful implementation of any EHR and will be beneficial in future policy decision making.
Caroline Nicholson, PhD Candidate, University of Queensland
To describe a "best practice" governance model which allows optimal linkage between Medicare Local and Hospital and Health Services (HHS's) activity.
What are the structures that contribute to sustainable clinical and organizational governance across the continuum of care?
What is the role of a shared e-portal in this governance framework?
Building on previous work this systematic review includes peer-reviewed (black) publications from electronic databases and a review of the relevant 'grey' literature. An observational study will describe activity and outcomes against each of the essential elements to integrated governance, as the Medicare Local/HHS's work together to development and delivery of integrated services for patients.
A governance framework for integrated primary/secondary health service delivery is described.
For the goals of health reform to be realised meso-level organisations in Australia must work together to achieve co-ordinated and integrated primary healthcare services, however there is a lack of evidence to suggest how this will be achieved. This study will develop a framework to be utilised in developing integrated primary/secondary clinical care for chronic and complex patients.
Susan Upham, Research Associate, University of Queensland
General practice charts of women with GDM participating in Mater Mothers' Hospital shared-care will be audited over a 12 month period. A short questionnaire will also be self-administered by the GDM women's GP to gain insight into their awareness and knowledge of GDM guidelines.
Outcomes will be informed by best-practice maternal health indicators: post-partum oral glucose tolerance test (OGTT), body mass index, blood pressure, mental health status and breast feeding status as well as GPs perceived use and usefulness of guidelines, information on post-partum reminder systems for patient follow up and information on post-partum OGTT testing.
Women who have had GDM have an increased risk of developing Type 2 diabetes. While current best practice recommends a postpartum OGTT within 6- 8 weeks of delivery, there is a gap in GDM research up to 12 months postpartum. This project will add knowledge to this under researched area, providing direction for health service delivery change, benefiting patients, policy makers, service providers, health care funders, and other researchers.
Commonwealth of Australia DoHaA. Building a 21st Century Primary Health Care System: Australia's First National Primary Health Care Strategy. Canberra, 2009: http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nphc-draft-report-toc#.T86-RMixqSo
Commonwealth of Australia. A National Health and Hospitals Network for Australia's Future: Delivering the Reformds, 2010: http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/DeliveringTheReforms/$FILE/DeliveringTheReforms.pdf.
Hirst C. Re-birthing - Report of the Review of Maternity Services in Queensland. Brisbane, Department of Health, 2005.
Jackson C, Jong D, Oats J. Clinical pathways involving general practice - a new approach to integrated health care? Australian Health Review 2000;23(2):88-95.
National Health and Medical Research Council. National Guidance on Collaborative Maternity Care, 2010: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/CP124.pdf.
Colyer S. Midwife talks hit roadblock. Australian Doctor 2010; June 11 http://www.australiandoctor.com.au/news/74/0c069f74.asp
Commonwealth of Australia. Overcoming Indigenous Disadvantage Key Indicators 2009 Overview: Steering Committee for the Review of Government Service Provision: http://www.pc.gov.au/__data/assets/pdf_file/0003/90129/key-indicators-2009.pdf.
Commonwealth of Australia. Closing the Gap Prime Ministers Report, 2010: http:www.fahcsia.gov.au/sa/indigenous/pubs/general/Documents/ClosingtheGap2010/closingthegap2010.pdf.