Study 1- The Kanyini Vascular Audit
Cardiovascular disease (CVD), chronic kidney disease (CKD) and diabetes are the leading causes of premature death and disability among Australians. Aboriginal and Torres Strait Islander people are disproportionately affected. These complex and related chronic diseases are 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 chronic disease risk factors should not be managed in isolation. Integrated ‘whole person’ 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.
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.
The specific objectives of this study are to:
- Determine how effective primary care services are in screening for vascular conditions among their adult regular adult 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 factors that relates to high and low quality of care and adherence to treatment guidelines.
Review of records
The Vascular Audit involved a retrospective review of primary care records of a random selection of 1200 regular attendees from participating Aboriginal Medical Services.
This study aimed to review up to 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 has been 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 have participated in finalising the audit methodology and structure. Where feasible, Indigenous Research Fellows have been 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.
- 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.
Kanyini Audit - Study progress:
Where are we up to at March 2009?
For the vascular audit, a total of 1165 records were audited from eight indigenous health services with feedback given to individual sites. The first paper for publication for this study has been submitted and we are confident that it will provide important insights into cardiovascular disease risk management for Aboriginal and Torres Strait Islander peoples in primary health care settings.
Data collection is nearing completion for the systems level audit component of the Kanyini Audit. In conjunction with the Kanyini Qualitative study we are proposing a mixed methods analysis of health service structures. We hope that this will provide a policy- relevant understanding of how the ‘system’ level relates to quality care practices for individuals.