The Kanyini Vascular Audit
Background
Cardiovascular disease (CVD) is the leading cause of premature death and disability in Australia. Aboriginal and Torres Strait Islander people are disproportionately affected by this burden and CVD is the main reason for the widening gap in life expectancy between Indigenous and non-Indigenous people.
There is now a substantial body of evidence showing that CVD risk factors interact synergistically and that no one risk factor should be managed in isolation. Integrated global risk assessment approaches are almost universally recommended in national and international guidelines.
Despite these guidelines, evidence-practice gaps are wide. The complexities of identifying people at high risk and making practical links to guideline-based care are probably significant contributors to treatment gaps.
Goal
The primary goal of the Kanyini Vascular Audit is to quantify the magnitude of evidence-practice gaps in the identification and management of vascular risk among Aboriginal and Torres Strait Islander people.
Objectives
The specific objectives of this study are to:
- Determine how effective primary care services are in screening for vascular conditions among their adult regular attendees.
- Outline the vascular risk profile of a representative sample.
- Determine the quality of care delivered to patients identified with elevated risk.
- Describe the structure, performance and availability of chronic disease services.
- Describe system level correlates of quality of care and adherence to treatment guidelines.
Study Design
Review of records
The Vascular Audit will involve a retrospective review of primary care records of a random selection of 1200 regular attendees from participating Aboriginal Medical Services.
This study aims to review at least 200 Aboriginal and Torres Strait Islander adult case records (aged 18 years and over) from each site. It will describe:
- the proportion of adults in the sample who have risk assessments performed and
- the spectrum of vascular risk identified in these records.
Where risk is identified, treatment gaps will be measured against a range of guidelines.
The uptake of the Adult Health Check will also be assessed along with the adequacy of risk assessments performed in those adults who have received this check.
Systems level audit
The review will be complemented by a Systems Level Audit which will focus on:
- the structures that support systematic management of vascular disease within each participating primary care service and
- the availability, performance, and accessibility of secondary specialist support services in each site.
Scientific and Operation Advisory Committees
A clinical governance group comprising representatives of the study investigators and local study site co-investigators will be established to oversee the development of the audit tools, administration, data feedback strategies and implementation of performance monitoring frameworks.
Health service staff and local advisory committees will participate in finalising the audit methodology and structure. Where feasible, Indigenous Research Fellows will be trained and supported to conduct data collection, analysis and feedback to the participating health services. These audits will inform quality frameworks within participating health services.
Expected Outcomes
- Documentation of the adequacy of screening systems in identifying Aboriginal and Torres Strait Islander people with high vascular risk.
- Quantification of the evidence-practice gap in the prevention and management of elevated vascular risk across urban, rural and remote primary care services.
- The identification of health system deficits in assessment and management of elevated vascular risk for Aboriginal and Torres Straight Islander people.
- Assessment of the contribution of EPC items to improved identification and management of vascular risk.
- Increased capacity within Aboriginal Community Controlled Health Services (ACCHS) for chronic disease and health systems research.
- Provision of a baseline assessment of health service practices prior to the intervention studies of the broader program.