Centre for Primary Health Care Systems, Menzies School of Health Research , Brisbane, QLD , Australia.
Department of Public Health, School of Psychology and Public Health, LaTrobe University , Melbourne, VIC , Australia.
Front Public Health. 2016 Mar 30;4:53. doi: 10.3389/fpubh.2016.00053. eCollection 2016.
Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers.
虽然临床医疗保健的某些领域已经熟练地掌握了实施持续质量改进（CQI）项目的方法，但在健康促进方面，CQI 的实验性应用却有限。在这项研究中，我们考察了 CQI 干预对澳大利亚四家原住民初级保健中心健康促进的影响。我们的研究目的是：(a) 描述健康促进活动的范围和质量；(b) 描述健康中心系统对健康促进活动的支持状况；(c) 引入 CQI 干预措施，并在两年内考察其对健康促进活动和健康中心系统的影响。基线评估显示，健康中心系统对健康促进的支持不足，且存在明显的证据-实践差距。经过两个年度的 CQI 周期，员工对健康促进的理解有所提高，且已经引入了用于规划和记录健康促进活动的系统。虽然采取了一些行动来改进最佳实践的健康促进活动，例如社区参与和部门间合作，但健康中心系统的组织方式限制了这些行动的实施，该系统主要用于支持临床和治疗服务。这些发现表明，CQI 通过让一线卫生保健工作者参与健康中心系统的设计/重新设计决策过程，从而为实施最佳实践的健康促进提供了机会，进而可以提高基于证据的健康促进的实施效果。然而，要进一步和持续地改善健康促进，还需要管理人员、高级工作人员和当地社区成员更广泛地参与，以解决组织和政策层面的障碍。
