Exploring systems that support good clinical care in Indigenous primary health-care services: a retrospective analysis of longitudinal systems assessment tool data from high-improving services

Background: Continuous quality improvement is a process for raising the quality of primary health care across Indigenous PHC services. In addition to clinical auditing using plan, do, study, act cycles, engaging staff in a process of reflecting on systems to support quality care is vital. The One21seventy Systems Assessment Tool (SAT) supports staff to assess systems performance in terms of five key components. This study examines quantitative and qualitative SAT data from five high-improving Indigenous primary health care services in northern Australia to understand the systems used to support quality care. Methods: High improving services selected for the study were determined by calculating quality of care indices for Indigenous health services participating in the ABCD National Research Partnership. Services that reported continuing high improvement in quality of care delivered across two or more audit tools in three or more audits were selected for the study. Pre-collected SAT data (from annual team SAT meetings) is presented longitudinally using radar plots for quantitative scores for each component and content analysis is used to describe strengths and weaknesses of performance in each systems component. Results: High improving services were able to demonstrate strong processes for assessing system performance and consistent improvement in systems to support quality care across components. Key strengths in the quality support systems included adequate and orientated workforce, appropriate health system supports and engagement with other organisations and community while the weaknesses included lack of service infrastructure, recruitment, retention and support for staff and additional costs. Qualitative data revealed clear voices from health service staff expressing concerns with performance and subsequent SAT data provided evidence of changes made to address concerns. Conclusion: Learning from the processes and strengths of high-improving services may be useful as we work with services striving to improve the quality of care provided in other areas

PenQuest Volume 3, Number 1

The Table of Contents for this Volume: Untitled by R. Bruce Warner Seeing the Unseen by Sharon Gresham Untitled by Helen Hagadorn Untitled by Steve Balunan Happy Holidays by Donna Kaluzniak River-walking, Night-talking by William Slaughter Ribbon of Light by Judith Mizrahi Love in Parentheses by Sharon Gresham Untitled by Steve Balunan Protohistory by Patricia Kraft Untitled by Bruce Abbey Untitled by Rick Wagner Thanatopsis by Pat Kraft Untitled by Sue Hightower Untitled by Rick Wagner Conversations of a Woman by Sharon Gresham Thur, Fri, Sat, at Mr. B\u27s by Patricia Kraft Untitled by Rick Wagner Untitled by Cindy Carlisle Untitled by Win Lyons Untitled by Cindy Carlisle Untitled by Modesta Matthews Untitled by James Tutten A Light at Mill Pond Crossing by Joe Palmer Untitled by Rick Wagner Two People by Kathleen Gay Untitled by Rick Wagner American Dream (Russian Version) by William Slaughter Untitled by Judith Mizrahi Untitled by Linda Willco

Clinical validation of cutoff target ranges in newborn screening of metabolic disorders by tandem mass spectrometry: A worldwide collaborative project

PURPOSE:: To achieve clinical validation of cutoff values for newborn screening by tandem mass spectrometry through a worldwide collaborative effort. METHODS:: Cumulative percentiles of amino acids and acylcarnitines in dried blood spots of approximately 25-30 million normal newborns and 10,742 deidentified true positive cases are compared to assign clinical significance, which is achieved when the median of a disorder range is, and usually markedly outside, either the 99th or the 1st percentile of the normal population. The cutoff target ranges of analytes and ratios are then defined as the interval between selected percentiles of the two populations. When overlaps occur, adjustments are made to maximize sensitivity and specificity taking all available factors into consideration. RESULTS:: As of December 1, 2010, 130 sites in 45 countries have uploaded a total of 25,114 percentile data points, 565,232 analyte results of true positive cases with 64 conditions, and 5,341 cutoff values. The average rate of submission of true positive cases between December 1, 2008, and December 1, 2010, was 5.1 cases/day. This cumulative evidence generated 91 high and 23 low cutoff target ranges. The overall proportion of cutoff values within the respective target range was 42% (2,269/5,341). CONCLUSION:: An unprecedented level of cooperation and collaboration has allowed the objective definition of cutoff target ranges for 114 markers to be applied to newborn screening of rare metabolic disorders. © 2011 Lippincott Williams & Wilkins

Implementing stakeholder engagement to explore alternative models of consent: An example from the PREP-IT trials

Introduction: Cluster randomized crossover trials are often faced with a dilemma when selecting an optimal model of consent, as the traditional model of obtaining informed consent from participant's before initiating any trial related activities may not be suitable. We describe our experience of engaging patient advisors to identify an optimal model of consent for the PREP-IT trials. This paper also examines surrogate measures of success for the selected model of consent. Methods: The PREP-IT program consists of two multi-center cluster randomized crossover trials that engaged patient advisors to determine an optimal model of consent. Patient advisors and stakeholders met regularly and reached consensus on decisions related to the trial design including the model for consent. Patient advisors provided valuable insight on how key decisions on trial design and conduct would be received by participants and the impact these decisions will have. Results: Patient advisors, together with stakeholders, reviewed the pros and cons and the requirements for the traditional model of consent, deferred consent, and waiver of consent. Collectively, they agreed upon a deferred consent model, in which patients may be approached for consent after their fracture surgery and prior to data collection. The consent rate in PREP-IT is 80.7%, and 0.67% of participants have withdrawn consent for participation. Discussion: Involvement of patient advisors in the development of an optimal model of consent has been successful. Engagement of patient advisors is recommended for other large trials where the traditional model of consent may not be optimal