Implementation Science
Volume 10, Issue 1, 2015

Bridging the Gap: Using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities (Article) (Open Access)

Yelland J.* , Riggs E. , Szwarc J. , Casey S. , Dawson W. , Vanpraag D. , East C. , Wallace E. , Teale G. , Harrison B. , Petschel P. , Furler J. , Goldfeld S. , Mensah F. , Biro M.A. , Willey S. , Cheng I.-H. , Small R. , Brown S.
  • a Murdoch Children's Research Institute, Healthy Mothers Healthy Families Research Group, Parkville, VIC 3052, Australia, University of Melbourne, Department of General Practice and Primary Health Care Academic Unit, Parkville, VIC, Australia
  • b Murdoch Children's Research Institute, Healthy Mothers Healthy Families Research Group, Parkville, VIC 3052, Australia, University of Melbourne, Department of General Practice and Primary Health Care Academic Unit, Parkville, VIC, Australia
  • c Victorian Foundation for Survivors of Torture, Brunswick, VIC, Australia
  • d Victorian Foundation for Survivors of Torture, Brunswick, VIC, Australia
  • e Murdoch Children's Research Institute, Healthy Mothers Healthy Families Research Group, Parkville, VIC 3052, Australia
  • f Murdoch Children's Research Institute, Healthy Mothers Healthy Families Research Group, Parkville, VIC 3052, Australia
  • g Monash Health, Monash Women's Maternity Services, Clayton, VIC, Australia, Monash University, School of Nursing and Midwifery, Clayton, VIC, Australia, Monash University, The Ritchie Centre, Clayton, VIC, Australia
  • h Monash Health, Monash Women's Maternity Services, Clayton, VIC, Australia, Monash University, The Ritchie Centre, Clayton, VIC, Australia, Monash University, Department of Obstetrics and Gynaecology, Clayton, VIC, Australia
  • i Women's and Children's Services, Western Health, Sunshine, VIC, Australia, University of Melbourne, Department Obstetrics and Gynaecology, Parkville, VIC, Australia
  • j Maternal and Child Health, City of Greater Dandenong, Dandenong, VIC, Australia
  • k Maternal and Child Health, City of Wyndham, Wyndham, VIC, Australia
  • l University of Melbourne, Department of General Practice and Primary Health Care Academic Unit, Parkville, VIC, Australia
  • m Murdoch Children's Research Institute, Royal Children's Hospital, Centre for Community Child Health, Parkville, VIC, Australia, University of Melbourne, Department of Paediatrics, Parkville, VIC, Australia
  • n University of Melbourne, Department of Paediatrics, Parkville, VIC, Australia, Royal Children's Hospital, Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, VIC, Australia
  • o Monash University, School of Nursing and Midwifery, Clayton, VIC, Australia
  • p Monash University, School of Nursing and Midwifery, Clayton, VIC, Australia
  • q South Eastern Melbourne Medicare Local, Dandenong, VIC, Australia, Monash University, Southern Academic Primary Care Research Unit, Dandenong, VIC, Australia
  • r La Trobe University, Judith Lumley Centre, Melbourne, VIC, Australia
  • s Murdoch Children's Research Institute, Healthy Mothers Healthy Families Research Group, Parkville, VIC 3052, Australia, University of Melbourne, Department of General Practice and Primary Health Care Academic Unit, Parkville, VIC, Australia, University of Melbourne, School of Population Health, Parkville, VIC, Australia

Abstract

Background: The risk of poor maternal and perinatal outcomes in high-income countries such as Australia is greatest for those experiencing extreme social and economic disadvantage. Australian data show that women of refugee background have higher rates of stillbirth, fetal death in utero and perinatal mortality compared with Australian born women. Policy and health system responses to such inequities have been slow and poorly integrated. This protocol describes an innovative programme of quality improvement and reform in publically funded universal health services in Melbourne, Australia, that aims to address refugee maternal and child health inequalities. Methods/design: A partnership of 11 organisations spanning health services, government and research is working to achieve change in the way that maternity and early childhood health services support families of refugee background. The aims of the programme are to improve access to universal health care for families of refugee background and build organisational and system capacity to address modifiable risk factors for poor maternal and child health outcomes. Quality improvement initiatives are iterative, co-designed by partners and implemented using the Plan Do Study Act framework in four maternity hospitals and two local government maternal and child health services. Discussion: It is envisaged that the Bridging the Gap program will provide essential evidence to support service and policy innovation and knowledge about what it takes to implement sustainable improvements in the way that health services support vulnerable populations, within the constraints of existing resources. © 2015 Yelland et al.

Author Keywords

quality improvement Process evaluation Refugee families Time series design Universal health services Partnerships

Index Keywords

Quality Improvement total quality management refugee Australia methodology Research Design health disparity Health Status Disparities human epidemiology Refugees Humans maternal child health care female risk factor Risk Factors pregnancy Interrupted Time Series Analysis standards organization and management Maternal-child Health Services pregnancy outcome capacity building public sector Health Services Accessibility health care delivery
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84947650565&doi=10.1186%2fs13012-015-0251-z&partnerID=40&md5=2c6d1a5d1d25dc8d059300977fb45c7b
DOI: 10.1186/s13012-015-0251-z
ISSN: 17485908
Cited by: 12
Original Language: English