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Table 2 Research and health system focus of ABCD program of work

From: A systems-based partnership learning model for strengthening primary healthcare

  ABCD ABCD extension One21seventy ABCD national research partnership (2010 – 2014)
(2002 – 2006) (2005 – 2009) (2010 – )
Research questions Could a QI approach be feasible and effective in Indigenous PHC services? What was required to support large-scale implementation of the ABCD model? No direct research function. Voluntary contribution of data by services for research purposes, and potential for other involvement of services in research Understanding variation in quality of care and strategies for improvement.
Exploring feasibility/functioning of a national system-based research network.
Health system strengthening dimension QI approach embraced as way of improving (and demonstrating) quality of care. Informed health system planning and policy by showing how the ABCD approach could be scaled up, examined barriers/enablers to engagement and improvement. Provides QI training and tools with systems thinking focus; web-based data reporting system able to produce local and aggregated data reports, with benchmarking. Brings together stakeholders from across jurisdictions and levels of health system to support and guide research on priority CPHC health system issues, contribute to refinement of QI tools and processes, interpretation of data, application of findings, and share lessons.
Systems assessment tool (SAT) provided a mechanism for ongoing local system improvement and integration with other organizations and sectors (CPHC focus)
130+ health services and staff exposed to and used ABCD QI tools and processes over the 5-year project.
200+ health services using ABCD tools and processes by early 2013.
Research findings QI approach was well accepted, demonstrated feasibility of application of tools and processes, and improvements in care and intermediate health outcomes Identified key barriers and enablers to scaling up in Aboriginal and Torres Strait Islander context Increasing numbers of services that are engaged with One21seventy are participating in the ABCD Research Partnership – now about 70% – demonstrating increasing trust and interest in research. To date focus has been on development of the Partnership, defining priority research questions, development of protocols and implementation of research, development of new priority tools.
Health system strengthening outcomes Improvements in quality of care delivered + some intermediate health outcomes Three State/Territory governments and a number of regional health services elected to implement the ABCD approach on a broad scale. Increased interest and support for QI. ABCD tools made available for use in a national QI program and for broader use by individual services and health affiliates. Three State/Territory health services and several regional and local health authorities contract One21seventy to provide QI support to over 200 PHC services in five Australian States/Territories, including commitment of infrastructure support for QI. Regional and national priority research questions being addressed through collaborative research
Improved morale and team-building Inter- and intra-jurisdictional and regional relationships strengthened.
Findings and data used by health leaders advocate for systematic QI processes. Data and research findings used by health leaders for advocacy purposes to advance system strengthening.
Further questions raised How could the approach be scaled up for more widespread application? Highlighted large variations in quality of care across health services—how could this be understood, addressed? How best can a not-for-profit operate sustainably to support health-system strengthening in the Aboriginal and Torres Strait Islander context? What is the impact of a systems-based research network (SBRN), itself a complex adaptive system (CAS) operating on other CASs?
What is the impact of the One21seventy QI support service? What will enable the effective engagement of stakeholders with responsibility for social determinants of health in a CPHC-oriented SBRN?