Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2005

Open Access 01-12-2005 | Research article

Assessing health centre systems for guiding improvement in diabetes care

Authors: Damin Si, Ross Bailie, Christine Connors, Michelle Dowden, Allison Stewart, Gary Robinson, Joan Cunningham, Tarun Weeramanthri

Published in: BMC Health Services Research | Issue 1/2005

Login to get access

Abstract

Background

Aboriginal people in Australia experience the highest prevalence of diabetes in the country, an excess of preventable complications and early death. There is increasing evidence demonstrating the importance of healthcare systems for improvement of chronic illness care. The aims of this study were to assess the status of systems for chronic illness care in Aboriginal community health centres, and to explore whether more developed systems were associated with better quality of diabetes care.

Methods

This cross-sectional study was conducted in 12 Aboriginal community health centres in the Northern Territory of Australia. Assessment of Chronic Illness Care scale was adapted to measure system development in health centres, and administered by interview with health centre staff and managers. Based on a random sample of 295 clinical records from attending clients with diagnosed type 2 diabetes, processes of diabetes care were measured by rating of health service delivery against best-practice guidelines. Intermediate outcomes included the control of HbA1c, blood pressure, and total cholesterol.

Results

Health centre systems were in the low to mid-range of development and had distinct areas of strength and weakness. Four of the six system components were independently associated with quality of diabetes care: an increase of 1 unit of score for organisational influence, community linkages, and clinical information systems, respectively, was associated with 4.3%, 3.8%, and 4.5% improvement in adherence to process standards; likewise, organisational influence, delivery system design and clinical information systems were related to control of HbA1c, blood pressure, and total cholesterol.

Conclusion

The state of development of health centre systems is reflected in quality of care outcome measures for patients. The health centre systems assessment tool should be useful in assessing and guiding development of systems for improvement of diabetes care in similar settings in Australia and internationally.
Appendix
Available only for authorised users
Literature
1.
National Centre for Monitoring Diabetes: Diabetes: Australian Facts. 2002, Canberra: AIHW
2.
McDermott R, Tulip F, Schmidt B, Sinha A: Sustaining better diabetes care in remote indigenous Australian communities. BMJ. 2003, 327: 428-430. 10.1136/bmj.327.7412.428.CrossRefPubMedPubMedCentral
3.
Simmons D: Impact of an integrated approach to diabetes care at the Rumbalara Aboriginal Health Service. Intern Med J. 2003, 33: 581-585. 10.1111/j.1445-5994.2003.00491.x.CrossRefPubMed
4.
Bailie RS, Si D, Robinson GW, Togni SJ, D'Abbs PH: A multifaceted health-service intervention in remote Aboriginal communities: 3-year follow-up of the impact on diabetes care. Med J Aust. 2004, 181: 195-200.PubMed
5.
Wagner EH: Chronic disease management: what will it take to improve care for chronic illness?. Eff Clin Pract. 1998, 1: 2-4.PubMed
6.
Bodenheimer T: Interventions to improve chronic illness care: evaluating their effectiveness. Dis Manag. 2003, 6: 63-71. 10.1089/109350703321908441.CrossRefPubMed
7.
Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A: Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001, 20: 64-78. 10.1377/hlthaff.20.6.64.CrossRef
8.
Weeramanthri T, Hendy S, Connors C, Ashbridge D, Rae C, Dunn M, Fittock M, Cleary J, O'Donohoe L, Morton S, Swanson N: The Northern Territory preventable chronic disease strategy – promoting an integrated and life course approach to chronic disease in Australia. Aust Health Rev. 2003, 26: 31-42.CrossRefPubMed
9.
Hoffmann B, Bailie R: Health-related housing and infrastructure in the Northern Territory Aboriginal Communities: 2001 data. 2003, Darwin: Cooperative Research Centre for Aboriginal and Tropical Health
10.
11.
Bonomi AE, Wagner EH, Glasgow RE, VonKorff M: Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Health Serv Res. 2002, 37: 791-820. 10.1111/1475-6773.00049.CrossRefPubMedPubMedCentral
12.
Central Australian Rural Practitioner Association: CARPA standard treatment manual: a clinic manual for primary health care practitioners in remote and rural communities in Central and Northern Australia. 2003, Alice Springs: Central Australian Rural Practitioner Association, 4
13.
Williams R, Herman W, Kinmonth AL, Wareham NJ: The evidence base for diabetes care. 2002, Chichester: John Wiley & Sons, LtdCrossRef
14.
Cappellari L, Jenkins S: Multivariate probit regression using simulated maximum likelihood. Stata Journal. 2003, 3: 278-294.
15.
StataCorp: Stata Statistical Software: release 8.2. 2003, College Station, TX: Stata Corporation
16.
Wagner EH, Glasgow RE, Davis C, Bonomi AE, Provost L, McCulloch D, Carver P, Sixta C: Quality improvement in chronic illness care: a collaborative approach. Jt Comm J Qual Improv. 2001, 27: 63-80.PubMed
17.
18.
Tapp RJ, Zimmet PZ, Harper CA, de Court, Balkau B, McCarty DJ, Taylor HR, Welborn TA, Shaw JE: Diabetes care in an Australian population: frequency of screening examinations for eye and foot complications of diabetes. Diabetes Care. 2004, 27: 688-693.CrossRefPubMed
19.
Chin MH, Auerbach SB, Cook S, Harrison JF, Koppert J, Jin L, Thiel F, Karrison TG, Harrand AG, Schaefer CT, Takashima HT, Egbert N, Chiu SC, McNabb WL: Quality of diabetes care in community health centers. Am J Public Health. 2000, 90: 431-434.CrossRefPubMedPubMedCentral
20.
Parsons J: Diabetes. Can systems change improve outcomes?. Aust Fam Physician. 2001, 30: 1116.PubMed
21.
Harris M, Blakeman T: Enhanced Primary Care items. Their use in diabetes management. Aust Fam Physician. 2001, 30: 1134-1140.PubMed
22.
Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness. JAMA. 2002, 288: 1775-1779. 10.1001/jama.288.14.1775.CrossRefPubMed
23.
Chaves N, Weeramanthri T, Mak D, Bunn L, Lines D, Morgan S, Girrabul J, Allen O: Diabetes audit can aid practice development in a range of Indigenous health care settings. Aust J Rural Health. 2001, 9: 251-253. 10.1046/j.1440-1584.2001.00397.x.CrossRefPubMed
24.
Fitzsimons B, Wilton L, Lamont T, McCulloch L, Boyce J: The Audit Commission review of diabetes services in England and Wales, 1998–2001. Diabet Med. 2002, 19 (Suppl 4): 73-78. 10.1046/j.1464-5491.19.s4.13.x.CrossRefPubMed
25.
Feifer C, Ornstein SM, Nietert PJ, Jenkins RG: System supports for chronic illness care and their relationship to clinical outcomes. Top Health Inf Manage. 2001, 22: 65-72.PubMed
26.
Sperl-Hillen JM, Solberg LI, Hroscikoski MC, Crain AL, Engebretson KI, O'Connor PJ: Do all components of the chronic care model contribute equally to quality improvement?. Jt Comm J Qual Saf. 2004, 30: 303-309.PubMed
27.
Elliott R: Regional statistics, Northern Territory 2004. 2004, Canberra: ABS
28.
McDermott RA, Schmidt BA, Sinha A, Mills P: Improving diabetes care in the primary healthcare setting: a randomised cluster trial in remote Indigenous communities. Med J Aust. 2001, 174: 497-502.PubMed
Metadata
Title
Assessing health centre systems for guiding improvement in diabetes care
Authors
Damin Si
Ross Bailie
Christine Connors
Michelle Dowden
Allison Stewart
Gary Robinson
Joan Cunningham
Tarun Weeramanthri
Publication date
01-12-2005
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2005
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-5-56

Other articles of this Issue 1/2005

BMC Health Services Research 1/2005 Go to the issue

Research article

The factors associated to psychosocial stress among general practitioners in Lithuania. Cross-sectional study

Research article

Translating research into policy and practice in developing countries: a case study of magnesium sulphate for pre-eclampsia

Research article

Hospital service areas – a new tool for health care planning in Switzerland

Erratum

Erratum To: The effect of executive walk rounds on nurse safety climate attitudes: A randomized trial of clinical units [ISRCTN85147255]

Research article

Cost-consciousness among Swiss doctors: a cross-sectional survey

Research article

Unhappy doctors? A longitudinal study of life and job satisfaction among Norwegian doctors 1994 – 2002