Evidence-informed practice development in rural Aboriginal Community Controlled Health Services: an action research approach phase one of four

Background: Aboriginal Controlled Community Health Organisations (ACCHOs) have a specific mandate to provide comprehensive primary healthcare to Aboriginal and/or Torres Strait Islander people within their community. The National Aboriginal and Torres Strait Islander Health Plan (2021-2031) centres ACCHOs as key enablers for change, with continuous quality improvement a mechanism for evaluating change to improve the health system. Systematic continuous quality improvement has been shown to improve care delivery and patient outcomes in the ACCHO sector, but improvements are not evenly distributed across services or care types. Thus, there is a need and recognition for evidence-based context-specific tailoring to put policy into practice in a flexible, locally relevant and sustainable way. To systematically guide improved outcomes and approaches, practices need to understand the impact of current health practice on the current patient population and the opportunities to increase access for non-service users. In addition, a local understanding of practice capacity and capability and the ability to leverage additional resources will inform improvement approaches. This presentation outlines the overall research then directs focus to the completed phase one.
Aims: Generate a practice population profile using routine data; analyse episodes of care with respect to population health needs and assess for gaps and opportunities; and perform practice capacity and stability assessment to inform phase two.
Methods: An action research frame, continuous quality improvement methodology and mixed methods were used. Phase one consisted of practice profile development and review of practice CQI processes. Qualitative data were collected via document review and yarning-style focus groups discussions and interviews with ACCHOS executives, practice managers, and staff including those involved in CQI. Thematic analyses were performed. Quantitative data were extracted from ACCHOS’ routinely collected data and analysed using descriptive statistics. Data were triangulated and synthesized.
Results: Themes: client-centred care and staff support underpinned by organisational and cultural values were enablers to improvement; program funding, staff retention and reporting systems were barriers to improvement. Results: improvements and areas for improvement in clinical measures.
Challenges: Delays in data availability due to: systems access disruptions; reporting incongruencies between funding, government and research bodies; workload and staffing disrupted progress; differences in data review perspectives between clinicians and researchers.
Take-home message: ACCHOs are values-based organisations that are underpinned by organisational and cultural values and principles that enable health service delivery and improvement. Opportunities for improvement were unique to each ACCHO and seen as the best local approaches to improve Aboriginal health.