Health section, Unicef Afghanistan, Kabul, Afghanistan.
Child and Adolescent Health Service, Government of Western Australia, Perth, Western Australia, Australia.
Arch Dis Child. 2019 Apr;104(4):372-380. doi: 10.1136/archdischild-2018-315164. Epub 2018 Aug 7.
Our primary objective was to assess if sustained participation in continuous quality improvement (CQI) activities could improve delivery of 'basic developmental care' to disadvantaged children in primary care settings. Secondary objectives were to assess if delivery of developmental care differed by age and geographic location.Data were analysed using multivariable logistic regression and generalised estimating equations. 109 indigenous primary care centres across Australia from 2012 to 2014 and2466 client files from indigenous children aged 3-59 months were included. Outcome measures were delivery of basic developmental care.We found that the proportion of children who received basic developmental care ranged from 55% (advice about physical and mental stimulation of child) (1279, 55.1%) to 74% (assessment of developmental milestones) (1510, 73.7%). Ninety-three per cent (92.6%, 88) of children received follow-up care. Centres with sustained CQI participation (completed three or more consecutive audit cycles) (508, 53.9%) were twofold more likely to deliver basic developmental care compared with centres without sustained CQI (completed less than three consecutive audit cycles) (118, 31.0%) (adjusted OR (aOR) 2.37, 95% CI 1.33 to 4.23). Children aged 3-11 months (229, 54.9%) were more likely to receive basic developmental care than children aged 24-59 months (151, 38.5%) (aOR 2.42, 95% CI 1.67 to 3.51). Geographic location had little effect (aOR 0.68, 95% CI 0.30 to 1.53). Overall our study found that sustained CQI can improve basic developmental care in primary care settings. However, many disadvantaged children are not receiving services. Improved resourcing of developmental care and CQI in primary care centres is needed.
我们的主要目标是评估持续参与持续质量改进（CQI）活动是否可以改善初级保健环境中弱势儿童的“基本发育护理”的提供。次要目标是评估发育护理的提供是否因年龄和地理位置而异。数据使用多变量逻辑回归和广义估计方程进行分析。2012 年至 2014 年，澳大利亚的 109 个土著初级保健中心和 2466 名 3-59 个月大的土著儿童的客户档案被纳入研究。结果是基本发育护理的提供情况。我们发现，接受基本发育护理的儿童比例从 55%（关于儿童身心刺激的建议）（1279 人，55.1%）到 74%（发育里程碑评估）（1510 人，73.7%）不等。93%（92.6%，88 人）的儿童接受了后续护理。与没有持续 CQI（完成不到三个连续审核周期）的中心（118 人，31.0%）相比，持续 CQI 参与（完成三个或更多连续审核周期）的中心（508 人，53.9%）更有可能提供基本发育护理（调整后的 OR（aOR）2.37，95%CI 1.33 至 4.23）。3-11 个月大的儿童（229 人，54.9%）比 24-59 个月大的儿童（151 人，38.5%）更有可能接受基本发育护理（aOR 2.42，95%CI 1.67 至 3.51）。地理位置的影响很小（aOR 0.68，95%CI 0.30 至 1.53）。总的来说，我们的研究发现持续的 CQI 可以改善初级保健环境中的基本发育护理。然而，许多弱势儿童没有得到服务。需要为初级保健中心的发育护理和 CQI 提供更好的资源。
