Public Service Research Group, Business School, UNSW Canberra, Canberra, Australia.
SenseMakers 4 Smarter Care, Port Macquarie, NSW, 2444, Australia.
BMC Health Serv Res. 2018 Jul 11;18(1):541. doi: 10.1186/s12913-018-3308-2.
BACKGROUND: Continuous Quality Improvement (CQI) programs have been taken up widely by Indigenous primary health care (PHC) services in Australia and there has been national policy commitment to support this. However, international evidence shows that implementing CQI is challenging, impacts are variable and little is known about the factors that impede or enhance effectiveness. A scoping review was undertaken to explore uptake and implementation in Indigenous PHC, including barriers and enablers to embedding CQI in routine practice. We provide guidance on how research and evaluation might be intensified to support implementation. METHODS: Searches were conducted in MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews. Key websites and publications were handsearched. Studies conducted in Indigenous PHC which demonstrated some combination of CQI characteristics and assessed some aspect of implementation were included. A two stage analysis was undertaken. Stage 1 identified the breadth and focus of literature. Stage 2 investigated barriers and enablers. The Framework for Performance Assessment in PHC (2008) was used to frame the analysis. Data were extracted on the study type, approach, timeframes, CQI strategies, barriers and enablers. RESULTS: Sixty articles were included in Stage 1 and 21 in Stage 2. Barriers to implementing CQI processes relate primarily to professional and organisational processes and operate at multiple levels (individual, team, service, health system) whereas barriers to improved care relate more directly to knowledge of best practice and team processes that facilitate appropriate care. Few studies described implementation timeframes, number of CQI cycles or improvement strategies implemented and only two applied a change theory. CONCLUSION: Investigating barriers and enablers that modify implementation and impacts of CQI poses conceptual and methodological challenges. More complete description of CQI processes, implementation strategies, and barriers and enablers could enhance capacity for comparisons across settings and contribute to better understanding of key success factors.
背景：持续质量改进 (CQI) 计划已在澳大利亚的土著初级卫生保健 (PHC) 服务中广泛采用，并且国家政策承诺支持这一计划。然而，国际证据表明，实施 CQI 具有挑战性，影响是可变的，并且对于阻碍或增强有效性的因素知之甚少。进行了范围审查，以探讨土著 PHC 中的采用和实施情况，包括将 CQI 嵌入常规实践中的障碍和促进因素。我们提供了关于如何加强研究和评估以支持实施的指导。
方法：在 MEDLINE、CINAHL 和 Cochrane 系统评价数据库中进行了搜索。对手册和出版物进行了手工搜索。纳入了在土著 PHC 中进行的、展示了某些 CQI 特征并评估了实施的某些方面的研究。进行了两阶段分析。第一阶段确定了文献的广度和重点。第二阶段调查了障碍和促进因素。使用初级保健绩效评估框架 (2008 年) 来构建分析。提取了关于研究类型、方法、时间范围、CQI 策略、障碍和促进因素的数据。
结果：在第一阶段纳入了 60 篇文章，在第二阶段纳入了 21 篇文章。实施 CQI 过程的障碍主要与专业和组织过程有关，并在多个层面上运作（个人、团队、服务、卫生系统），而改善护理的障碍则与最佳实践知识和促进适当护理的团队过程更直接相关。很少有研究描述实施时间范围、CQI 周期数量或实施的改进策略，只有两项应用了变更理论。
结论：调查影响 CQI 实施和影响的障碍和促进因素带来了概念和方法学上的挑战。更完整地描述 CQI 过程、实施策略以及障碍和促进因素，可以增强在不同环境中进行比较的能力，并有助于更好地理解关键成功因素。
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