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Dossetor PJ, Freeman JM, Thorburn K, Oscar J, Carter M, Jeffery HE, Harley D, Elliott EJ, Martiniuk ALC. Health services for aboriginal and Torres Strait Islander children in remote Australia: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001140. [PMID: 36962992 PMCID: PMC10022200 DOI: 10.1371/journal.pgph.0001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/21/2022] [Indexed: 02/15/2023]
Abstract
In Australia, there is a significant gap between health outcomes in Indigenous and non-Indigenous children, which may relate to inequity in health service provision, particularly in remote areas. The aim was to conduct a scoping review to identify publications in the academic and grey literature and describe 1) Existing health services for Indigenous children in remote Australia and service use, 2) Workforce challenges in remote settings, 3) Characteristics of an effective health service, and 4) Models of care and solutions. Electronic databases of medical/health literature were searched (Jan 1990 to May 2021). Grey literature was identified through investigation of websites, including of local, state and national health departments. Identified papers (n = 1775) were screened and duplicates removed. Information was extracted and summarised from 116 papers that met review inclusion criteria (70 from electronic medical databases and 45 from the grey literature). This review identified that existing services struggle to meet demand. Barriers to effective child health service delivery in remote Australia include availability of trained staff, limited services, and difficult access. Aboriginal and Community Controlled Health Organisations are effective and should receive increased support including increased training and remuneration for Aboriginal Health Workers. Continuous quality assessment of existing and future programs will improve quality; as will measures that reflect aboriginal ways of knowing and being, that go beyond traditional Key Performance Indicators. Best practice models for service delivery have community leadership and collaboration. Increased resources with a focus on primary prevention and health promotion are essential.
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Affiliation(s)
- Phillipa J Dossetor
- Clinical Medical School, College of Medicine, Biology & Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Joseph M Freeman
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Kathryn Thorburn
- Nulungu Research Institute, University of Notre Dame, Broome, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia
| | - Heather E Jeffery
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - David Harley
- Clinical Medical School, College of Medicine, Biology & Environment, Australian National University, Canberra, Australian Capital Territory, Australia
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute-UQ, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth J Elliott
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
- The Sydney Children's Hospital Network (Westmead), Kids Research, Westmead, Australia
| | - Alexandra L C Martiniuk
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- George Institute for Global Health, Sydney, Australia
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Dossetor PJ, Thorburn K, Oscar J, Carter M, Fitzpatrick J, Bower C, Boulton J, Fitzpatrick E, Latimer J, Elliott EJ, Martiniuk AL. Review of Aboriginal child health services in remote Western Australia identifies challenges and informs solutions. BMC Health Serv Res 2019; 19:758. [PMID: 31655576 PMCID: PMC6815358 DOI: 10.1186/s12913-019-4605-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite a national focus on closing the gap between Aboriginal and non-Aboriginal child health outcomes in Australia, there remain significant challenges, including provision of health services in very remote communities. We aimed to identify and map child health services in the very remote Fitzroy Valley, West Kimberley, and document barriers to effective service delivery. METHODS Identification and review of all regional child health services and staffing in 2013. Verification of data by interview with senior managers and staff of key providers in the Western Australian Country Health Service, Kimberley Population Health Unit, Nindilingarri Cultural Health Services and non-government providers. RESULTS We identified no document providing a comprehensive overview of child health services in the Fitzroy Valley. There were inadequate numbers of health professionals, facilities and accommodation; high staff turnover; and limited capacity and experience of local health professionals. Funding and administrative arrangements were complex and services poorly coordinated and sometimes duplicated. The large geographic area, distances, extreme climate and lack of public and private transport challenge service delivery. The need to attend to acute illness acts to deprioritise crucial primary and preventative health care and capacity for dealing with chronic, complex disorders. Some services lack cultural safety and there is a critical shortage of Aboriginal Health Workers (AHW). CONCLUSIONS Services are fragmented and variable and would benefit from a coordinated approach between government, community-controlled agencies, health and education sectors. A unifying model of care with emphasis on capacity-building in Aboriginal community members and training and support for AHW and other health professionals is required but must be developed in consultation with communities. Innovative diagnostic and care models are needed to address these challenges, which are applicable to many remote Australian settings outside the Fitzroy Valley, as well as other countries globally. Our results will inform future health service planning and strategies to attract and retain health professionals to work in these demanding settings. A prospective audit of child health services is now needed to inform improved planning of child health services with a focus on identifying service gaps and training needs and better coordinating existing services to improve efficiency and potentially also efficacy.
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Affiliation(s)
- Philippa J Dossetor
- Clinical Medical School, College of Medicine, Biology & Environment, Australian National University, ACT, Canberra, 2605, Australia.
| | - Kathryn Thorburn
- Nulungu Research Institute, University of Notre Dame, Broome, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Crossing, Fitzroy, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Crossing, Fitzroy, Australia
| | - James Fitzpatrick
- University of Sydney, Sydney Medical School, Sydney, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | | | - Emily Fitzpatrick
- University of Sydney, Sydney Medical School, Sydney, Australia.,The Sydney Children's Hospital Network (Westmead), Sydney, Australia
| | - Jane Latimer
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - Elizabeth J Elliott
- University of Sydney, Sydney Medical School, Sydney, Australia.,The Sydney Children's Hospital Network (Westmead), Sydney, Australia
| | - Alexandra Lc Martiniuk
- University of Sydney, Sydney Medical School, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia.,The University of Toronto, Toronto, Canada
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Mitchinson C, Strobel N, McAullay D, McAuley K, Bailie R, Edmond KM. Anemia in disadvantaged children aged under five years; quality of care in primary practice. BMC Pediatr 2019; 19:178. [PMID: 31164108 PMCID: PMC6547444 DOI: 10.1186/s12887-019-1543-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 05/20/2019] [Indexed: 01/07/2023] Open
Abstract
Background Anemia rates are over 60% in disadvantaged children yet there is little information about the quality of anemia care for disadvantaged children. Methods Our primary objective was to assess the burden and quality of anemia care for disadvantaged children and to determine how this varied by age and geographic location. We implemented a cross-sectional study using clinical audit data from 2287 Indigenous children aged 6–59 months attending 109 primary health care centers between 2012 and 2014. Data were analysed using multivariable regression models. Results Children aged 6–11 months (164, 41.9%) were less likely to receive anemia care than children aged 12–59 months (963, 56.5%) (adjusted odds ratio [aOR] 0.48, CI 0.35, 0.65). Proportion of children receiving anemia care ranged from 10.2% (92) (advice about ‘food security’) to 72.8% (728) (nutrition advice). 70.2% of children had a hemoglobin measurement in the last 12 months. Non-remote area families (115, 38.2) were less likely to receive anemia care compared to remote families (1012, 56.4%) (aOR 0.34, CI 0.15, 0.74). 57% (111) aged 6–11 months were diagnosed with anemia compared to 42.8% (163) aged 12–23 months and 22.4% (201) aged 24–59 months. 49% (48.5%, 219) of children with anemia received follow up. Conclusions The burden of anemia and quality of care for disadvantaged Indigenous children was concerning across all remote and urban locations assessed in this study. Improved services are needed for children aged 6–11 months, who are particularly at risk.
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Affiliation(s)
- Casey Mitchinson
- Perth Children's Hospital, Child and Adolescent Health Service, Government of Western Australia, Perth, Western Australia, Australia
| | - Natalie Strobel
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Daniel McAullay
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Kimberley McAuley
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Ross Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Karen M Edmond
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.
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Josif CM, Kruske S, Kildea SV, Barclay LM. The quality of health services provided to remote dwelling aboriginal infants in the top end of northern Australia following health system changes: a qualitative analysis. BMC Pediatr 2017; 17:93. [PMID: 28359332 PMCID: PMC5374585 DOI: 10.1186/s12887-017-0849-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/24/2017] [Indexed: 11/17/2022] Open
Abstract
Background In Australia the health outcomes of remote dwelling Aboriginal infants are comparable to infants in developing countries. This research investigates service quality, from the clinicians’ perspective and as observed and recorded by the researcher, in two large Aboriginal communities in the Top End of northern Australia following health system changes. Methods Data were collected from semi-structured interviews with 25 clinicians providing or managing child health services in the two study sites. Thirty hours of participant observation was undertaken in the ‘baby-rooms’ at the two remote health centres between June and December 2012. The interview and observational data, as well as field notes were integrated and analysed thematically to explore clinicians’ perspectives of service delivery to infants in the remote health centres. Results A range of factors affecting the quality of care, mostly identified before health system changes were instigated, persisted. These factors included ineffective service delivery, inadequate staffing and culturally unsafe practices. The six themes identified in the data: ‘very adhoc’, ‘swallowed by acute’, ‘going under’, ‘a flux’, ‘a huge barrier’ and ‘them and us’ illustrate how these factors continue, and when combined portray a ‘very chaotic system’. Conclusion Service providers perceived service provision and quality to be inadequate, despite health system changes. Further work is urgently needed to improve the quality, cultural responsiveness and effectiveness of services to this population. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0849-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cathryn M Josif
- University Centre for Rural Health Sydney School of Public Health, University of Sydney, Sydney, NSW, 2480, Australia.
| | - Sue Kruske
- School of Nursing Midwifery and Social Work, The University of Queensland (UQ), Brisbane, 4010, Australia
| | - Sue V Kildea
- School of Nursing Midwifery and Social Work, The University of Queensland (UQ), Brisbane, 4010, Australia
| | - Lesley M Barclay
- University Centre for Rural Health Sydney School of Public Health, University of Sydney, Sydney, NSW, 2480, Australia
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Greenstein C, Lowell A, Thomas DP. Improving physiotherapy services to Indigenous children with physical disability: Are client perspectives missed in the continuous quality improvement approach? Aust J Rural Health 2015; 24:176-81. [PMID: 26692226 DOI: 10.1111/ajr.12258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To compare the outcomes of two cycles of continuous quality improvement (CQI) at a paediatric physiotherapy service with findings from interviews with clients and their carers using the service. DESIGN Case study based at one paediatric physiotherapy service SETTING Community-based paediatric allied health service in Northern Australia. PARTICIPANTS Forty-nine clinical records and four staff at physiotherapy service, five Indigenous children with physical disability aged 8-21 years, and nine carers of Indigenous children aged 0-21 years (current or previous clients). INTERVENTIONS The CQI process based on the Audit and Best Practice for Chronic Disease involved a clinical audit; a workshop where clinicians assessed their health care systems, identified weaknesses and strengths, and developed goals and strategies for improvement; and reassessment through a second audit and workshop. Twelve open-ended, in-depth interviews were conducted with previous or current clients selected through purposive and theoretical sampling. CQI and interview results were then compared. MAIN OUTCOME MEASURE Comparison of findings from the two studies RESULTS Both CQI and interview results highlighted service delivery flexibility and therapists' knowledge, support and advocacy as service strengths, and lack of resources and a child-friendly office environment as weaknesses. However, the CQI results reported better communication and client input into the service than the interview results. CONCLUSION The CQI process, while demonstrating improvements in clinical and organisational aspects of the service, did not always reflect or address the primary concerns of Indigenous clients and underlined the importance of including clients in the CQI process.
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Affiliation(s)
- Caroline Greenstein
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anne Lowell
- Research Centre for Health and Wellbeing, Charles Darwin University, Darwin, Northern Territory, Australia
| | - David Piers Thomas
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Bar-Zeev SJ, Kruske SG, Barclay LM, Bar-Zeev N, Kildea SV. Adherence to management guidelines for growth faltering and anaemia in remote dwelling Australian Aboriginal infants and barriers to health service delivery. BMC Health Serv Res 2013; 13:250. [PMID: 23819687 PMCID: PMC3750842 DOI: 10.1186/1472-6963-13-250] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 06/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Remote dwelling Aboriginal infants from northern Australia have a high burden of disease and frequently use health services. Little is known about the quality of infant care provided by remote health services. This study describes the adherence to infant guidelines for anaemia and growth faltering by remote health staff and barriers to effective service delivery in remote settings. METHODS A mixed method study drew data from 24 semi-structured interviews with clinicians working in two remote communities in northern Australia and a retrospective cohort study of Aboriginal infants from these communities, born 2004-2006 (n = 398). Medical records from remote health centres were audited. The main outcome measures were the period prevalence of infants with anaemia and growth faltering and management of these conditions according to local guidelines. Qualitative data assessed clinicians' perspectives on barriers to effective remote health service delivery. RESULTS Data from 398 health centre records were analysed. Sixty eight percent of infants were anaemic between six and twelve months of age and 42% had documented growth faltering by one year. Analysis of the growth data by the authors however found 86% of infants experienced growth faltering over 12 months. Clinical management and treatment completion was poor for both conditions. High staff turnover, fragmented models of care and staff poorly prepared for their role were barriers perceived by clinicians' to impact upon the quality of service delivery. CONCLUSION Among Aboriginal infants in northern Australia, malnutrition and anaemia are common and occur early. Diagnosis of growth faltering and clinicians' adherence to management guidelines for both conditions was poor. Antiquated service delivery models, organisation of staff and rapid staff turnover contributed to poor quality of care. Service redesign, education and staff stability must be a priority to redress serious deficits in quality of care provided for these infants.
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Affiliation(s)
- Sarah J Bar-Zeev
- Centre for Rural Health, North Coast; Sydney School of Public Health, University of Sydney, New South Wales, Sydney 2480, Australia
| | - Sue G Kruske
- Queensland Centre for Mothers and Babies, School of Psychology, University of Queensland, Brisbane, Queensland 4072, Australia
| | - Lesley M Barclay
- Centre for Rural Health; North Coast, University of Sydney, New South Wales 2480, Sydney, Australia
| | - Naor Bar-Zeev
- Menzies School of Health Research, Charles Darwin University, Darwin, 0909, Sydney, Australia
- Malawi-Liverool-Wellcome Trust Clinical Research Programme, Institute of Infection and Global Health, University of Liverpool, Liverpool, Merseyside L69 3BX, UK
| | - Sue V Kildea
- Midwifery Research Unit, Australian Catholic University and the Mater Medical Research Institute, Queensland 4010, Brisbane, Australia
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Abstract
The recent Federal Government Report and Media release, Stronger Futures in the Northern Territory: Report on Consultations and its claim of 'widespread Indigenous Support' has brought the topic of the Northern Territory Emergency Response (the Intervention) back into the public mind. This article provides a synthesis of four years of debate around the Northern Territory Emergency Response, at a time when the program is nearing the end of its time frame. It outlines the main arguments supporting the Intervention, the central criticisms and the government's response to these evaluations, with the aim of providing a primer or summary for health professionals to the discussion around this important public issue.
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Affiliation(s)
- Brendon W Evans
- University of Queensland, Queensland Health Rural Scholarship Holder, Edens Landing, Queensland, Australia.
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D'Aprano AL, Carapetis JR, Andrews R. Trial of a developmental screening tool in remote Australian Aboriginal communities: a cautionary tale. J Paediatr Child Health 2011; 47:12-7. [PMID: 20973859 DOI: 10.1111/j.1440-1754.2010.01883.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To trial the Brigance developmental screening tool as an instrument for identifying Australian Aboriginal children at risk of developmental disability and requiring diagnostic developmental assessment. METHODS We conducted a cross-sectional study of Australian Aboriginal children, aged 3-7 years, resident in three remote communities in the Northern Territory. Following informed consent, children were screened by a paediatrician using the Brigance screen. RESULTS There were 195 children identified as eligible, and 124 (64%) participated. All children screened, scored below the cut-off for detecting children likely to have developmental disabilities or academic delays. Furthermore, all children scored below the at-risk cut-offs that indicate high probability of disabilities in at-risk children. CONCLUSIONS The Brigance screen identified all children in these high-risk Aboriginal communities as well behind their age peers. Language and cultural relevance, and the method of administration limit the use of this screening tool. However, we cannot ignore the uniformly poor performance on a mainstream tool used with children expected to succeed in a mainstream educational setting. Recommendations include adapting an appropriate instrument to guide developmental surveillance and monitoring in remote Australian Aboriginal communities. This study further supports the pressing need for quality early childhood services that address the significant risk confronting Aboriginal children and prepare them in a way that ensures school and future success.
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Affiliation(s)
- Anita L D'Aprano
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.
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Abstract
Despite Australia being one of the wealthiest countries of the world, Australian Indigenous children have a health status and social circumstance comparable to developing countries. Indigenous infants have 10 times the mortality rate for respiratory conditions. The lower respiratory infection (LRI) rate in Australian Indigenous children is at least as high as that of children in developing countries; the frequency of hospitalisations of Indigenous infants is triple that of non-Indigenous Australian infants (201.7 vs. 62.6/1000, respectively). While Indigenous Australian children have many risk factors for LRIs described in developing countries, there is little specific data, and hence, evidence-based intervention points are yet to be identified. Efficacy of conjugate vaccines for common bacterial causes of pneumonia has been less marked in Indigenous children than that documented overseas. Gaps in the management and prevention of disease are glaring. Given the burden of LRI in Indigenous children and the association with long-term respiratory dysfunction, LRIs should be addressed as a matter of priority.
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Affiliation(s)
- Kerry-Ann F O'Grady
- Child Health Division Centre for Clinical Research Excellence in Child and Adolescent Immunisation, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.
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Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples. BMC Health Serv Res 2010; 10:129. [PMID: 20482810 PMCID: PMC2882384 DOI: 10.1186/1472-6963-10-129] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 05/19/2010] [Indexed: 11/16/2022] Open
Abstract
Background Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE) project has facilitated the implementation of modern Continuous Quality Improvement (CQI) approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes. It has also highlighted substantial variation in quality of care. Through a partnership between academic researchers, service providers and policy makers, we are now implementing a study which aims to 1) explore the factors associated with variation in clinical performance; 2) examine specific strategies that have been effective in improving primary care clinical performance; and 3) work with health service staff, management and policy makers to enhance the effective implementation of successful strategies. Methods/Design The study will be conducted in Indigenous community health centres from at least six States/Territories (Northern Territory, Western Australia, New South Wales, South Australia, Queensland and Victoria) over a five year period. A research hub will be established in each region to support collection and reporting of quantitative and qualitative clinical and health centre system performance data, to investigate factors affecting variation in quality of care and to facilitate effective translation of research evidence into policy and practice. The project is supported by a web-based information system, providing automated analysis and reporting of clinical care performance to health centre staff and management. Discussion By linking researchers directly to users of research (service providers, managers and policy makers), the partnership is well placed to generate new knowledge on effective strategies for improving the quality of primary health care and fostering effective and efficient exchange and use of data and information among service providers and policy makers to achieve evidence-based resource allocation, service planning, system development, and improvements of service delivery and Indigenous health outcomes.
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