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Implement Sci. 2015 Apr 30;10:62. doi: 10.1186/s13012-015-0251-z.

Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities.

Author information

1
Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia. jane.yelland@mcri.edu.au.
2
Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia. jane.yelland@mcri.edu.au.
3
Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia. elisha.riggs@mcri.edu.au.
4
Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia. elisha.riggs@mcri.edu.au.
5
Victorian Foundation for Survivors of Torture, Brunswick, VIC, Australia. szwarcj@foundationhouse.org.au.
6
Victorian Foundation for Survivors of Torture, Brunswick, VIC, Australia. caseys@foundationhouse.org.au.
7
Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia. wendy.dawson@mcri.edu.au.
8
Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia. dannielle.vanpraag@mcri.edu.au.
9
Monash Women's Maternity Services, Monash Health, Clayton, VIC, Australia. christine.east@monash.edu.
10
School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia. christine.east@monash.edu.
11
The Ritchie Centre, Monash University, Clayton, VIC, Australia. christine.east@monash.edu.
12
Monash Women's Maternity Services, Monash Health, Clayton, VIC, Australia. euan.wallace@monash.edu.
13
The Ritchie Centre, Monash University, Clayton, VIC, Australia. euan.wallace@monash.edu.
14
Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia. euan.wallace@monash.edu.
15
Women's and Children's Services, Western Health, Sunshine, VIC, Australia. Glyn.Teale@wh.org.au.
16
Department Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia. Glyn.Teale@wh.org.au.
17
Maternal and Child Health, City of Greater Dandenong, Dandenong, VIC, Australia. bernadette.harrison@cgd.vic.gov.au.
18
Maternal and Child Health, City of Wyndham, Wyndham, VIC, Australia. Pauline.Petschel@wyndham.vic.gov.au.
19
Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia. j.furler@unimelb.edu.au.
20
Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia. sharon.goldfeld@mcri.edu.au.
21
Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia. sharon.goldfeld@mcri.edu.au.
22
Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia. fiona.mensah@mcri.edu.au.
23
Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia. fiona.mensah@mcri.edu.au.
24
School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia. maryanne.biro@monash.edu.
25
School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia. suzanne.willey@monash.edu.
26
South Eastern Melbourne Medicare Local, Dandenong, VIC, Australia. i.cheng@semml.com.au.
27
Southern Academic Primary Care Research Unit, Monash University, Dandenong, VIC, Australia. i.cheng@semml.com.au.
28
Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia. R.Small@latrobe.edu.au.
29
Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia. stephanie.brown@mcri.edu.au.
30
Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia. stephanie.brown@mcri.edu.au.
31
School of Population Health, University of Melbourne, Parkville, VIC, Australia. stephanie.brown@mcri.edu.au.

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. Bridging the Gap is designed as a multi-phase, quasi-experimental study. Evaluation methods include use of interrupted time series design to examine health service use and maternal and child health outcomes over a 3-year period of implementation. Process measures will examine refugee families' experiences of specific initiatives and service providers' views and experiences of innovation and change.

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.

PMID:
25924721
PMCID:
PMC4425879
DOI:
10.1186/s13012-015-0251-z
[Indexed for MEDLINE]
Free PMC Article

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