The Kirby Institute, UNSW Sydney, Wallace Wurth Building, Sydney, NSW 2052, Australia; and Corresponding author. Email:
S&K Girgis Medical Service, 1/13-15 Kingsway, Cronulla, NSW 2230, Australia.
Aust J Prim Health. 2020 Apr;26(2):178-183. doi: 10.1071/PY19070.
Data from 110 primary healthcare clinics participating in two or more continuous quality improvement (CQI) cycles in preventive care, which included syphilis testing performance (STP) for Aboriginal and Torres Strait Islander people aged between 15 and 54 years, were used to examine whether the number of audit cycles including syphilis testing was associated over time with STP improvement at clinic level in this specific measure of public health importance. The number of cycles per clinic ranged from two to nine (mode 3). As shown by medical record audit at entry to CQI, only 42 (38%) clinics had tested or approached 50% or more of their eligible clients for syphilis in the prior 24 months. Using mixed effects logistic regression, it was found that the odds of a clinic's STP relative to its first cycle increased only modestly. Counterintuitively, clinics undertaking the most preventive health CQI cycles tended to have the lowest STP throughout. Participation in a general preventive care CQI tool was insufficient to achieve and sustain high rates of STP for Aboriginal and Torres Strait Islander people required for public health benefit. Improving STP requires dedicated effort and greater understanding of barriers to effective CQI within and beyond clinic control.
利用参与两项或以上持续质量改进（CQI）周期的 110 家初级保健诊所的数据，这些周期包含针对年龄在 15 至 54 岁之间的原住民和托雷斯海峡岛民的梅毒检测表现（STP），以检验在这一公共卫生重要指标中，诊所层面的 STP 改进是否与包括梅毒检测在内的审计周期数量有关。每家诊所的周期数量从两个到九个不等（模式 3）。在进入 CQI 时的医疗记录审计中，仅有 42（38%）家诊所过去 24 个月内对其 50%或以上的符合条件的客户进行了梅毒检测或接近 50%的检测。采用混合效应逻辑回归分析，发现诊所 STP 的几率与其第一个周期相比仅略有增加。违反直觉的是，进行最多预防性健康 CQI 周期的诊所的 STP 反而最低。参加一般的预防性保健 CQI 工具不足以实现和维持原住民和托雷斯海峡岛民的高 STP，而这是公共卫生的要求。提高 STP 需要专门的努力，以及更深入地了解诊所内部和外部有效 CQI 的障碍。
