Exploring Quality Improvement for Diabetes Care: A Multiple Case Study of Primary Care Teams in First Nations Communities in Canada

Clinical quality improvement (QI) teams from First Nations communities across Canada participated in an 18-month QI collaborative program called the TransFORmation of IndiGEnous Primary HEAlthcare Delivery (FORGE AHEAD) clinical QI initiative. Community-based participatory research and multiple case study methodologies were utilized to explore the experience of two clinical QI teams from diverse primary care settings in First Nations communities as they engaged in developing and implementing changes in practice to improve the quality of diabetes care. This study provides insight into how clinical QI teams drew upon multiple sources of knowledge and information to inform their QI activities, the importance of strengthening relationships and building partnerships with the community, and the factors that support or hinder QI within First Nations communities in Canada. The knowledge generated may help inform community action and future development and implementation of QI programs in First Nations communities in Canada

Co-creating an Evaluation Approach for a Healthy Relationships Program with Community Partners: Lessons Learned and Recommendations

Community-based partnerships are integral to mental health programming and research. However, there are limited published guidelines that apply the principles of community-based participatory research (CBPR), especially within the context of supporting vulnerable youth populations. This article demonstrates the application of the CBPR principles in cocreating an evaluation approach for a healthy relationships program for vulnerable youths with community partners. We present our research procedures and activities and highlight the importance of having a trauma-informed lens and flexibility with the research process and outcomes. We conclude the article by sharing our lessons learned and providing recommendations for future CBPR with vulnerable youths

Exploring quality improvement for diabetes care in First Nations communities in Canada: a multiple case study

Abstract Background Indigenous peoples in Canada experience higher rates of diabetes and worse outcomes than non-Indigenous populations in Canada. Strategies are needed to address underlying health inequities and improve access to quality diabetes care. As part of the national FORGE AHEAD Research Program, this study explores two primary healthcare teams’ quality improvement (QI) process of developing and implementing strategies to improve the quality of diabetes care in First Nations communities in Canada. Methods This study utilized a community-based participatory and qualitative case study methodology. Multiple qualitative data sources were analyzed to understand: (1) how knowledge and information was used to inform the teams’ QI process; (2) how the process was influenced by the context of primary care services within communities; and (3) the factors that supported or hindered their QI process. Results The findings of this study demonstrate how teams drew upon multiple sources of knowledge and information to inform their QI work, the importance of strengthening relationships and building relationships with the community, the influence of organizational support and capacity, and the key factors that facilitated QI efforts. Conclusions This study contributes to the ongoing calls for research in understanding the process and factors affecting the implementation of QI strategies, particularly within Indigenous communities. The knowledge generated may help inform community action and the future development, implementation and scale-up of QI programs in Indigenous communities in Canada and globally

National survey of indigenous primary healthcare capacity and delivery models in Canada: the TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) community profile survey

Background: There is a significant deficiency of national health information for Indigenous peoples in Canada. This manuscript describes the Community Profile Survey (CPS), a community-based, national-level survey designed to identify and describe existing healthcare delivery, funding models, and diabetes specific infrastructure and programs in Indigenous communities. Methods: The CPS was developed collaboratively through FORGE AHEAD and the First Nations and Inuit Health Branch of Health Canada. Regional and federal engagement and partnerships were built with Indigenous organizations to establish regionally-tailored distribution of the 8-page CPS to 440 First Nations communities. Results were collected (one survey per community) and reported in strata by region, with descriptive analyses performed on all variables. Results were shared with participating communities and regional/federal partners through tailored reports. Results: A total of 84 communities completed the survey (19% response rate). The majority of communities had a health centre/office to provide service to their patients with diabetes, with limited on-reserve hospitals for ambulatory or case-sensitive conditions. Few healthcare specialists were located on-site, with patients frequently travelling off-site (> 40 km) for diabetes-related complications. The majority of healthcare professionals on-site were Health Directors, Community Health Nurses, and Home Care Nurses. Many communities had a diabetes registry but few reported a diabetes surveillance system. Regional variation in healthcare services, diabetes programs, and funding models were noted, with most communities engaging in some type of innovative strategy to improve care for patients with diabetes. Conclusions: The CPS is the first community-based, national-level survey of its kind in Canada. Although the response rate was low, the CPS was distributed and successfully administered across a broad range of First Nations communities, and future considerations would benefit from a governance structure and leadership that strengthens community engagement, and a longitudinal research approach to increase the representativeness of the data. This type of information is important for communities and regions to inform decision making (maintain successes, and identify areas for improvement), strengthen health service delivery and infrastructure, increase accessibility to healthcare personnel, and allocate funding and/or resources to build capacity and foster a proactive chronic disease prevention and management approach for Indigenous communities across Canada. Trial registration: Current ClinicalTrial.gov protocol ID NCT02234973. Registered: September 9, 2014