Developing community-driven quality improvement initiatives to enhance chronic disease care in Indigenous communities in Canada: the FORGE AHEAD program protocol

Mariam Naqshbandi Hayward, Jann Paquette-Warren, Stewart B Harris, FORGE AHEAD Program Team, Mariam Naqshbandi Hayward, Jann Paquette-Warren, Stewart B Harris, FORGE AHEAD Program Team

Abstract

Background: Given the dramatic rise and impact of chronic diseases and gaps in care in Indigenous peoples in Canada, a shift from the dominant episodic and responsive healthcare model most common in First Nations communities to one that places emphasis on proactive prevention and chronic disease management is urgently needed.

Methods: The Transformation of Indigenous Primary Healthcare Delivery (FORGE AHEAD) Program partners with 11 First Nations communities across six provinces in Canada to develop and evaluate community-driven quality improvement (QI) initiatives to enhance chronic disease care. FORGE AHEAD is a 5-year research program (2013-2017) that utilizes a pre-post mixed-methods observational design rooted in participatory research principles to work with communities in developing culturally relevant innovations and improved access to available services. This intensive program incorporates a series of 10 inter-related and progressive program activities designed to foster community-driven initiatives with type 2 diabetes mellitus as the action disease. Preparatory activities include a national community profile survey, best practice and policy literature review, and readiness tool development. Community-level intervention activities include community and clinical readiness consultations, development of a diabetes registry and surveillance system, and QI activities. With a focus on capacity building, all community-level activities are driven by trained community members who champion QI initiatives in their community. Program wrap-up activities include readiness tool validation, cost-analysis and process evaluation. In collaboration with Health Canada and the Aboriginal Diabetes Initiative, scale-up toolkits will be developed in order to build on lessons-learned, tools and methods, and to fuel sustainability and spread of successful innovations.

Discussion: The outcomes of this research program, its related cost and the subsequent policy recommendations, will have the potential to significantly affect future policy decisions pertaining to chronic disease care in First Nations communities in Canada.

Trial registration: Current ClinicalTrial.gov protocol ID NCT02234973 . Date of Registration: July 30, 2014.

Keywords: Chronic disease; Complex interventions; Diabetes; First Nations; Indigenous; Quality improvement.

Figures

Fig. 1
Fig. 1
Map of partnering First Nations communities in the FORGE AHEAD Program separated by implementation wave
Fig. 2
Fig. 2
FORGE AHEAD governance structure schematic
Fig. 3
Fig. 3
FORGE AHEAD Program activities by phases
Fig. 4
Fig. 4
Readiness consultation and QI initiatives process

References

    1. World Health Organization. 10 Facts about Diabetes. 2016. . Accessed 10 Feb 2016.
    1. Coleman K, Mattke S, Perrault PJ, Wagner EH. Untangling practice redesign from disease management: how do we best care for the chronically ill? Annu Rev Public Health. 2009;30:385–408. doi: 10.1146/annurev.publhealth.031308.100249.
    1. Friedberg MW, Hussey PS, Schneider EC. Primary care: a critical review of the evidence on quality and costs of health care. Health Aff (Millwood) 2010;29:766–772. doi: 10.1377/hlthaff.2010.0025.
    1. Hutchison B, Levesque JF, Strumpf E, Coyle N. Primary health care in Canada: systems in motion. Milbank Q. 2011;89:256–288. doi: 10.1111/j.1468-0009.2011.00628.x.
    1. Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, Lin JK, Farzadfar F, Khang Y-H, Stevens GA, Rao M, Ali MK, Riley LM, Robinson CA, Ezzati M. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: Systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011;378:31–40.
    1. Zhang P, Zhang X, Brown J, Vistisen D, Sicree R, Shaw J, Nichols G. Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:293–301.
    1. Dyck RF, Hayward MN, Harris SB, CIRCLE Study Group Prevalence, determinants and co-morbidities of chronic kidney disease among First Nations adults with diabetes: results from the CIRCLE study. BMC Nephrol. 2012;13:57. doi: 10.1186/1471-2369-13-57.
    1. Harris SB, Naqshbandi M, Bhattacharyya O, Hanley AJG, Esler JG, Zinman B. Major gaps in diabetes clinical care among Canada’s First Nations: Results of the CIRCLE study. Diabetes Res Clin Pract. 2011;92:272–279. doi: 10.1016/j.diabres.2011.02.006.
    1. Young TK, Reading J, Elias BO, Neil BO. Type 2 diabetes mellitus in Canada’s First Nations: status of an epidemic in progress. Can Med Assoc J. 2000;163:561–566.
    1. Bramley D, Hebert P, Jackson R, Chassin M. Indigenous disparities in disease-specific mortality, a cross-country comparison: New Zealand, Australia, Canada, and the United States. N Z Med J. 2004;117:1204–1215.
    1. Pohar SL, Johnson JA. Health care utilization and costs in Saskatchewan’s registered Indian population with diabetes. BMC Health Serv Res. 2007;7:126. doi: 10.1186/1472-6963-7-126.
    1. Gracey M, King M. Indigenous health part 1: determinants and disease patterns. Lancet. 2009;374:65–75. doi: 10.1016/S0140-6736(09)60914-4.
    1. Nettleton CC, Napolitano DA, Stephens C. An Overview of Current Knowledge of the Social Determinants of Indigenous Health. Working Paper. Symposium on the Social Determinants of Indigenous Health, Adelaide, Australia 29–30, April 2007. Geneva: Commission on Social Determinants of Health (World Health Organization); 2007.
    1. Health Canada . Fact Sheet - First Nations and Inuit Health Branch. 2008.
    1. Health Canada. Aboriginal Diabetes Initiative Program Framework 2010–2015.
    1. Ten years of health transfer to First Nations and Inuit control. . Accessed 10 Feb 2016.
    1. Minore SB, Boone M, Katt M, Kinch P, Birch S. Facilitating the Continuity of Care for First Nation Clients within a Regional Context. 2001. . Accessed 10 Feb 2016.
    1. Ministry Advisory Council on Rural Health. Rural Health in Rural Hands: Strategic Directions for Rural, Remote, Northern and Aboriginal Communities. Health Canada. 2002. . Accessed 10 Feb 2016.
    1. National Collaborating Centre for Aboriginal Health. The Aboriginal Health Legislation and Policy Framework in Canada. Report – Context. Prince George: National Collaborating Centre for Aboriginal Health; 2011.
    1. King M, Smith A, Gracey M. Indigenous health part 2: the underlying causes of the health gap. Lancet. 2009;374:76–85. doi: 10.1016/S0140-6736(09)60827-8.
    1. Lavoie JG, Forget EL, Prakash T, Dahl M, Martens P, O’Neil JD. Have investments in on-reserve health services and initiatives promoting community control improved First Nations’ health in Manitoba? Soc Sci Med. 2010;71:717–724. doi: 10.1016/j.socscimed.2010.04.037.
    1. Shah BR, Gunraj N, Hux JE. Markers of access to and quality of primary care for aboriginal people in Ontario, Canada. Am J Public Health. 2003;93:798–802. doi: 10.2105/AJPH.93.5.798.
    1. Bailie KRS, Si D, Dowden M, Lonergan. Audit and Best Practice for Chronic Disease Project Final Report. 2007. . Accessed 10 Feb 2016.
    1. Department of Health and Human Services, Prevention. Special Diabetes Program for Indians: Community-Directed Successful Interventions and Sustained Achievements. 2012. . Accessed 10 Feb 2016.
    1. Tobe SW, Pylypchuk G, Wentworth J, Kiss A, Szalai JP, Perkins N, Hartman S, Ironstand L, Hoppe J. Effect of nurse-directed hypertension treatment among First Nations people with existing hypertension and diabetes mellitus: the Diabetes Risk Evaluation and Microalbuminuria (DREAM 3) randomized controlled trial. CMAJ. 2006;174:1267–71.
    1. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Project Hope) 2001;20:64–78. doi: 10.1377/hlthaff.20.6.64.
    1. Barr VJ, Robinson S, Marin-Link B, Underhill L, Dotts A, Ravensdale D, Salivaras S. The expanded Chronic Care Model: an integration of concepts and strategies from population health promotion and the Chronic Care Model. Hosp Q. 2003;7:73–82.
    1. Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the Chronic Care Model in the new millennium. Health Aff (Project Hope) 2009;28:75–85. doi: 10.1377/hlthaff.28.1.75.
    1. Canadian Diabetes Association . 2015 Report on Diabetes: Driving Change. Toronto, ON: CDA; 2015.
    1. Ontario Ministry of Health and Long-Term Care. Preventing and Managing Chronic Disease: Ontario’s Framework. 2007. . Accessed 10 Feb 2016.
    1. Chin MH, Drum ML, Guillen M, Rimington A, Levie JR, Kirchhoff AC, Quinn MT, Schaefer CT. Improving and sustaining diabetes care in community health centers with the health disparities collaboratives. Med Care. 2007;45:1135–43.
    1. Harris S, Paquette-Warren J, Roberts S, Fournie M, Thind A, Ryan BL, Thorpe C, Terry AL, Brown JB, Stewart M, Webster-Bogaert S. Results of a mixed-methods evaluation of partnerships for health: a quality improvement initiative for diabetes care. J Am Board Fam Med. 2013;26:711–9.
    1. Philis-Tsimikas LCA, Gilmer TP, Schultz J, Walker C, Fortmann AL, Gallo LC. Community-centred programs: can they be the basis of innovative transformations in our health care practice? Implications from 15 years of testing, translating, and implementing community-based, culturally tailored diabetes management programs. Clin Diabetes. 2012;30:156–63.
    1. Shojania KG, Ranji SR, McDonald KM, Grimshaw JM, Sundaram V, Rushakoff RJ, Owens DK. Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA. 2006;296:427–40.
    1. Tricco AC, Ivers NM, Grimshaw JM, Moher D, Turner L, Galipeau J, Halperin I, Vachon B, Ramsay T, Manns B, Tonelli M, Shojania K. Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. Lancet. 2012;379:2252–61.
    1. Paquette-Warren J, Roberts SE, Fournie M, Tyler M, Brown J, Harris S. Improving chronic care through continuing education of interprofessional primary healthcare teams: a process evaluation. J Interprof Care. 2014;28:232–238. doi: 10.3109/13561820.2013.874981.
    1. Bhattacharyya OK, Rasooly IR, Naqshbandi M, Estey EA, Esler J, Toth E, Macaulay AC, Harris SB. Challenges to the provision of diabetes care in first nations communities: results from a national survey of healthcare providers in Canada. BMC Health Serv Res. 2011;11:283.
    1. Fisher TL, Burnet DL, Huang ES, Chin MH, Cagney KA. Cultural leverage: interventions using culture to narrow racial disparities in health care. Med Care Res Rev MCRR. 2007;64(5 Suppl):243S–282S. doi: 10.1177/1077558707305414.
    1. Cargo M, Mercer SL. The value and challenges of participatory research: strengthening its practice. Annu Rev Public Health. 2008;29:325–350. doi: 10.1146/annurev.publhealth.29.091307.083824.
    1. Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: Assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19:173–202. doi: 10.1146/annurev.publhealth.19.1.173.
    1. Gaventa J, Cornwall A. Challenging the Boundaries of the Possible: Participation, Knowledge and Power. IDS Bulletin. 2006;37(6):122–128. doi: 10.1111/j.1759-5436.2006.tb00329.x.
    1. Macaulay AC, Commanda LE, Freeman WL, Gibson N, McCabe ML, Robbins CM, Twohig PL. Participatory research maximises community and lay involvement. Br Med J. 1999;319:774–8.
    1. Minkler M, Wallerstein N. Community-Based Participatory Research for Health: from Process to Outcomes. 2. San Francisco: Jossey-Bass; 2008.
    1. Wallerstein RN, Oestzel J, Duran B, Tafoya G, Belone L, Rae. What Predicts Outcomes in CBPR? In: Minkler NM, Wallerstein N, editors. Community-Based Participatory Research for Health. San Francisco: Jossey-Bass; 2008. p. 371–92.
    1. Davis K, Schoen C, Schoenbaum S, Doty M, Holmgren A, Kriss J, Shea K. Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care. The Commonwealth Fund. 2012. . Accessed 10 Feb 2016.
    1. Paquette-Warren J, Naqshbandi Hayward M, Tompkins J, Harris S. Time to evaluate diabetes and guide health research and policy innovation: The Diabetes Evaluation Framework (DEFINE) Can J Program Eval. 2014;29:1–20. doi: 10.3138/cjpe.29.2.1.
    1. The National Diabetes Management Strategy. FORGE AHEAD Program Description . Accessed 10 Feb 2016.
    1. First Nations Information Centre. OCAP. 2016. . Accessed 10 Feb 2016.
    1. Macaulay AC, Harris SB, Lévesque L, Cargo M, Ford E, Salsberg J, McComber A, Fiddler R, Kirby R, Hanley AJG, Potvin L, Zinman B, Gittelsohn J, Phillips K, Receveur O. Primary prevention of type 2 diabetes: experiences of 2 Aboriginal communities in Canada. Can J Diabetes. 2003;27:464–75.
    1. Rice K, Te Hiwi B, Zwarenstein M, Lavallee B, Barre E, Harris SB, FORGE AHEAD program team Best practices for management and prevention of diabetes and obesity-related chronic disease among Indigenous peoples in Canada: a review. Can J Diabetes. 2016;40(3):216–225. doi: 10.1016/j.jcjd.2015.10.007.
    1. Edwards RW, Jumper-Thurman P, Plested BA, Oetting ER, Swanson L. Community readiness: research to practice. J Community Psychol. 2000;28:291–307. doi: 10.1002/(SICI)1520-6629(200005)28:3<291::AID-JCOP5>;2-9.
    1. Kelly KJ, Edwards RW, Comello MLG, Plested BA, Thurman PJ, Slater MD. The Community Readiness Model: a complementary approach to social marketing. Mark Theory. 2003;3:411–426. doi: 10.1177/1470593103042006.
    1. Thurman PJ, Vernon IS, Plested B. Advancing HIV/AIDS prevention among American Indians through capacity building and the community readiness model. J Public Health Manag Pract JPHMP. 2007;Suppl:S49–54.
    1. Kostadinov I, Daniel M, Stanley L, Gancia A, Cargo M. A systematic review of community readiness tool applications: implications for reporting. Int J Environ Res Public Health. 2015;12:3453–3468. doi: 10.3390/ijerph120403453.
    1. Systems Assessment Tool. . Accessed 10 Feb 2016.
    1. Si D, Bailie R, Connors C, Dowden M, Stewart A, Robinson G, Cunningham J, Weeramanthri T. Assessing health centre systems for guiding improvement in diabetes care. BMC Health Serv Res. 2005;5:56.
    1. Langley GJ. The improvement guide: a practical approach to enhancing organizational performance. 2. San Francisco: Jossey-Bass; 2009.
    1. Institute for Healthcare Improvement . The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. Cambridge, MA: IHI; 2003.
    1. Molina-Ortiz EI, Vega AC, Calman NS. Patient registries in primary care: essential element for quality improvement. Mt Sinai J Med. 2012;79:475–480. doi: 10.1002/msj.21328.
    1. Paquette-Warren J, Harris SB, Naqshbandi Hayward M, Tompkins JW. Case study of evaluations that go beyond clinical outcomes to assess quality improvement diabetes programmes using the Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE). J Eval Clin Pract. 2016. Ahead of print.
    1. Canadian Institutes of Health Research. Guide to Knowledge Translation Planning at CIHR: Integrated and End-of-Grant Approaches. Ottawa: CIHR; 2012. . Accessed 10 Feb 2016.
    1. Gardner K, Bailie R, Si D, O’Donoghue L, Kennedy C, Liddle H, Cox R, Kwedza R, Fittock M, Hains J, Dowden M, Connors C, Burke H, Beaver C. Reorienting primary health care for addressing chronic conditions in remote Australia and the South Pacific: review of evidence and lessons from an innovative quality improvement process. Aust J Rural Health. 2011;19:111–7.

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