Assessing and improving the quality of maternity care in Indigenous primary health services.

Halving the gap in the rate of mortality between Indigenous and other Australian children aged under fi ve, within a decade, is one of the key targets of the Australian Government’s ‘Close the Gap’ campaign. Improving the delivery of antenatal care has been identifi ed as a major strategy to achieve this target. Between 2005 and 2009, the Audit and Best Practice for Chronic Disease (ABCD) Extension project led by Prof Ross Bailie developed and implemented a systematic continuous quality improvement (CQI) process in a variety of Indigenous primary health centres. The process involved a plan–do–study–act annual cycle of quality improvement, supported by evidence-based tools and protocols for clinical audit. Tools were available in a wide range of program areas, including maternal health. Baseline audits of maternal health records conducted in 34 participating centres revealed both strengths and weaknesses in the delivery of antenatal care. Documentation of routine investigations and brief interventions/ advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling and 51% of women had a record of investigation for gestational diabetes. However, there was relatively good documentation of follow up of identified problems (e.g. over 70% of women with hypertension were referred to a GP/ Obstetrician). Data are now available for 76 centres that have participated in up to five annual cycles of quality improvement and elected to focus on maternal health care. This presentation will discuss the preliminary analysis of this data, which has identified a clear trend towards improving quality of care.