Quality Assurance for Aboriginal Medical Services (QAAMS) (Current)
Description
The Quality Assurance for Aboriginal Medical Services (QAAMS) program sought to provide culturally appropriate and clinically effective diabetes management through the use of two “point of care” pathology tests (PoCT): glycosylated haemoglobin (HbA1c) and urine albumin/creatinine ratio (ACR), at participating Aboriginal and Torres Strait Islander health services across Australia. A management framework of training, technical support and quality monitoring, and a program for Aboriginal community leaders ensured that pathology testing met the quality achieved in conventional pathology laboratories. There was an Australia-wide network of sites (150 in 2010-2011) for PoCT to assist in effective diabetes management in Indigenous communities.
to develop mechanisms to foster and encourage greater Aboriginal leadership and expertise within the Project
to increase the participation rate of Aboriginal Medical Services (AMSs) andAboriginal Community Controlled Health Services (ACCHSs) in the Program
to oversee the maintenance of the internal quality control and external quality assurance processes.
These aims and objectives were achieved by this project.
Outcomes
The number of services enrolled in the QAAMS Program for HbA1c and ACR increased by 78% (from 60 to 107) to 146% (from 37 to 91) during the contract period of 2006 to 2009. Two recruitment drives resulted in the cap of 100 services participating in the program being exceeded which necessitated a contract variation.
A telephone hotline support service was set up and manned by a qualified scientist from the Flinders University Community Point-of-Care Services (CPS) unit during business hours (9am to 5pm[CST] Monday to Friday) across the contract period. Total calls in were 1650 and total calls out were 2185.
A quarterly QAAMS newsletter on issues relevant to the QAAMS program was routinely produced and sent to all participants, and later posted on the QAAMS website.
A QAAMS Clinical Support Officer was appointed in early 2006.
Information was provided to AMSs and ACCHSs to ensure the appropriate use and understanding of the Medicare Rebate.
The QAAMS Program Manager liaised consistently with Bayer (now Siemens HealthCare Diagnostics) to ensure participants received high quality services in relation to the provision of reagents, quality control (QC) and consumables, and technical support for the DCA 2000 PoCT device.
The Flinders CPS unit undertook a major program of work called the QAAMS Diabetes Outcome Study midway through the contract period to validate the clinical effectiveness of QAAMS by collecting and analysing serial PoCT HbA1c results from patients with established diabetes from different services participating in QAAMS. Results from this analysis showed:
a statistically significant reduction in mean HbA1c of 0.5% (from 8.8% to 8.3%) in this group of patients over a median time of observation of 29 months (p<0.0001)
the time period over which PoCT was monitored (a median of 2.5 years) indicated that improvements in mean glycaemic control occurred over the long term and were not just short-term changes
a separate means of analysis showed a trend towards improved diabetic control; a 12% increase in the percentage of patients achieving a HbA1c <8%, a 7% reduction in the percentage of patients having a HbA1c between 8% and 10%, and a 6% reduction in patients with poorly controlled diabetes.
There were significant advances and new initiatives in the delivery of training in PoCT for QAAMS participants including:
redevelopment of the QAAMS primary training resources
The annual QAAMS Workshops increased their attendance rates between 2001 and 2008.
The QAAMS Leaders Group was formed in May 2006 whereby one person of Aboriginal or Torres Strait Islander descent was selected to represent each State or Territory. They developed a Mission Statement for QAAMS and a Terms of Reference document and played an integral role in:
assessing training resources for their cultural appropriateness
assisting with regional training visits by the primary QAAMS Training Team
delivering the annual QAAMS Workshop through program development, training assistance, delivering specific core sessions and making presentations.
The Flinders CPS unit and Royal College of Pathologists of Australasia Quality Assurance Programs Pty Ltd (RCPA QAP) held 29 meetings to collectively review the quality control and quality assurance results from each QAAMS site across the contract period.
The QAAMS Management Team published papers about QAAMS in two peer-reviewed papers, and the Program Manager delivered invited lectures on the QAAMS Program at a number of conferences/meetings.
Findings
Face-to-face training and competency assessment through on-site visits to individual services or regional workshops were crucial core activities.
The latter development of supporting on-line web-streamed training video and competency processes meant more device operators could be trained through this medium. This was a useful adjunct for training, but was not intended to replace face-to-face training which was the most effective means of delivering training for device operators in the QAAMS Program.
Recommendations
The QAAMS Program should embrace the opportunity to include new PoCT devices as they enter the Australian market, provided they meet analytical goals and are safe for patient care. This may involve new challenges to develop training and quality management processes that can support these new devices.
The QAAMS Management team should further engage the QAAMS Leaders to assist the scientific team in establishing contact with and rectifying the issues causing poor participation in QC testing regimes.
The constant change of health service personnel in the locations made the continuity of a high quality PoCT service and maintenance of training support difficult to sustain. The introduction of web-based training available 24hrs a day 7 days a week, and training DVDs, addressed this issue to some extent, but the fundamental issue of staff retention in rural and remote Australia will remain a permanent issue for QAAMS.
High staff turnover is also associated with the maintenance of regular QC testing regimens.
Data collection for the Diabetes Outcome Study was labour intensive and not streamlined despite the easy-to-follow templates and processes designed and implemented to assist this process. Processes are in place to address this issue.
Specific funding was provided by the Commonwealth Government in the 2009 Budget for four years. The success of the QAAMS program also led to Flinders University International Centre being able to use the QAAMS model to assist in the development of “point of care” pathology testing programs in other countries which currently include Canada, South Africa, Thailand and New Zealand.
Areas for Future Consideration
Further funding for QAAMS will be considered under the new Chronic Disease Prevention and Service Improvement Fund.
