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BMJ Qual Saf doi:10.1136/bmjqs-2011-000460
  • Quality improvement report

The Australian Primary Care Collaboratives Program: improving diabetes care

Open Access
  1. James Best4
  1. 1The Improvement Foundation (Australia), Adelaide, South Australia, Australia
  2. 2Dianella Community Health, Melbourne, Victoria, Australia
  3. 3The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
  4. 4Melbourne Medical School FMDHS, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Andrew W Knight, The Improvement Foundation (Australia), PO Box 3645, Adelaide, South Australia 5000, Australia; awknight{at}aapt.net.au
  1. Contributors AK wrote the article. DF, RA, SC and JB participated in the expert reference panel, provided comments and edited during writing. All authors provided approval to publish.

  • Accepted 15 April 2012
  • Published Online First 16 June 2012

Abstract

Problem Diabetes is a major, growing health problem often managed in primary care but with suboptimal control of risk factors.

Design A large-scale quality improvement collaborative implemented in seven waves.

Setting General practices and Aboriginal medical services across Australia.

Key measures for improvement Percentage of patients in each health service with haemoglobin A1C (HbA1C), total cholesterol and blood pressure at target.

Strategy for change Health services attended three 2-day workshops, separated by 3-month activity periods and followed by 12 months of further improvement work. Local collaborative program managers supported teams to report measures and plan/do/study/act (PDSA) cycles monthly. Health services received feedback about changes in their measures in comparison with their wave.

Effects of change 743 health services participated in seven waves between 2004 and 2009 serving approximately 150 000 people with diabetes. Mean numbers of patients at target HbA1c levels improved by 50% from 25% at baseline to 38% at month 18. Lipid and blood pressure measures showed similar improvement.

Lessons learnt Engagement in the Program and results demonstrated that the collaborative methodology is transferable to Australian primary care. The results may reflect improved data recording and disease coding, and changes in clinical care. Internal evaluation should be built into improvement projects from the start to facilitate improvements and reporting. Enthusing, training and resourcing practice teams appeared to be the key to rapid change. Local support of practice teams was instrumental in improvement. Early investment to facilitate automatic measure collection ensured good data reporting.

Footnotes

  • Funding The Australian Primary Care Collaboratives Program is funded by the Australian government Department of Health and Ageing and delivered by the Improvement Foundation (Australia) Ltd. The Improvement Foundation is a not-for-profit organisation whose core business is to provide expertise in the development and delivery of quality improvement programs to bring about systems change.

  • Competing interests None.

  • Ethics approval As a government-sponsored quality improvement project which used de-identified aggregated data for quality improvement purposes only, the Improvement Foundation was advised that ethics approval was not necessary for this Program.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This article publishes a small indicative subset of the data collected by the APCC Program in the course of its improvement work. The complete dataset is held by the Improvement Foundation and is subject to agreements with participating health services which restrict its use. Researchers wishing to access the data may make direct contact with the Improvement Foundation (Australia).

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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