Are we there yet? Closing the gap in indigenous health in Australia: Monitoring clinical performance in Aboriginal and Islander community control health services in Queensland
Introduction: Aboriginal people in Australia continue to experience a high burden of chronic disease, including cardiovascular disease. Aboriginal Medical Services (AMSs) are a significant component of the effort to reduce this burden and must be supported to deliver the highest quality care.
Objectives: To evaluate clinical health care performance in Queensland Aboriginal and Islander Health Council (QAIHC) member Aboriginal Medical Services (AMSs) in Australia.
Methods: In October 2009, AMSs in Queensland began to use a standard indicator set, the QAIHC Core Indicators, to monitor recorded prevalence and management performance on a number of key risk factors, clinical care activities and chronic diseases. Data is extracted monthly from clinic electronic medical record systems (EMRs) and submitted to a web based portal for services to review their performance over time and benchmarked. A copy of the data is also sent to the QAIHC data repository to allow agreed secondary analysis to occur. In July 2011 longitudinal data was analysed to examine trends in the number of participating services, proportion of patients with current recording of key health care activities and the prevalence of risk factors and cardiovascular disease.
Results: From October 2009 to July 2011, AMSs sending data for the QAIHC Core Indicators increased from 6 to 15 participants; the number of patients for whom data was captured increased from 10,800 to 26,004 of whom 19,634 (75.5%) were regular Indigenous patients in July 2011. The aggregated performance of participating services was consistent and excellent on the recording of a number of number of key risk factors and health care activities (for example tobacco use, blood pressure) and poor for others, with some improvement over time. Performance Variation in performance between services was greatest for care planning and health check activity. Hypertension was identified in a total of 2567 (19.2%) regular Indigenous adult patients, with a range in prevalence of 12–36% across the 15 services. The care delivered for hypertension was universally good.
Conclusion: The prevalence of hypertension is high in the Aboriginal Community in Australia, its management by AMSs across Queensland meeting best practice standards. Indicator sets built into existing information systems provides useful timely information for Aboriginal Medical Services. Lessons learnt should enable a similar system to be implemented in AMSs across Australia in 2012.
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