***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background — Despite effective treatments to reduce cardiovascular disease risk , their translation into practice is limited . Methods and Results — Using a parallel arm cluster-r and omized controlled trial in 60 Australian primary healthcare centers , we tested whether a multifaceted quality improvement intervention comprising computerized decision support , audit/feedback tools , and staff training improved ( 1 ) guideline -indicated risk factor measurements and ( 2 ) guideline -indicated medications for those at high cardiovascular disease risk . Centers had to use a compatible software system , and eligible patients were regular attendees ( Aboriginal and Torres Strait Isl and er people aged ≥35 years and others aged ≥45 years ) . Patient-level analyses were conducted using generalized estimating equations to account for clustering . Median follow-up for 38 725 patients ( mean age , 61.0 years ; 42 % men ) was 17.5 months . Mean monthly staff support was < 1 hour/site . For the co primary outcomes , the intervention was associated with improved overall risk factor measurements ( 62.8 % versus 53.4 % risk ratio ; 1.25 ; 95 % confidence interval , 1.04–1.50 ; P=0.02 ) , but there was no significant differences in recommended prescriptions for the high-risk cohort ( n=10 308 ; 56.8 % versus 51.2 % ; P=0.12 ) . There were significant treatment escalations ( new prescriptions or increased numbers of medicines ) for antiplatelet ( 4.3 % versus 2.7 % ; P=0.01 ) , and BP lowering ( 18.2 % versus 11.0 % ; P=0.02 ) but not lipid-lowering medications . Conclusions — In Australian primary healthcare setting s , a computer-guided quality improvement intervention , requiring minimal support , improved cardiovascular disease risk measurement but did not increase prescription rates in the high-risk group . Computerized quality improvement tools offer an important , albeit partial , solution to improving primary healthcare system capacity for cardiovascular disease risk management . Clinical Trial Registration — URL : https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=336630 . Australian New Zeal and Clinical Trials Registry No. 12611000478910 Objective Continuous quality improvement ( CQI ) methods are foundational approaches to improving healthcare delivery . Publications using the term CQI , however , are method ologically heterogeneous , and labels other than CQI are used to signify relevant approaches . St and ards for identifying the use of CQI based on its key method ological features could enable more effective learning across quality improvement ( QI ) efforts . The objective was to identify essential method ological features for recognizing CQI . Design Previous work with a 12-member international expert panel identified reliably abstract ed CQI method ological features . We tested which features met rigorous a priori st and ards as essential features of CQI using a three-phase online modified-Delphi process . Setting Primarily United States and Canada . Participants 119 QI experts r and omly assigned into four on-line panels . Intervention(s ) Participants rated  CQI features and discussed their answers using online , anonymous and asynchronous discussion boards . We analyzed ratings quantitatively and discussion threads qualitatively . Main outcome measure(s ) Panel consensus on definitional CQI features . Results Seventy-nine ( 66 % ) panelists completed the process . Thirty-three completers self-identified as QI research ers , 18 as QI practitioners and 28 as both equally . The features ‘ systematic data guided activities , ’ ‘ design ing with local conditions in mind ’ and ‘ iterative development and testing ’ met a priori st and ards as essential CQI features . Qualitative analyses showed cross-cutting themes focused on differences between QI and CQI . Conclusions We found consensus among a broad group of CQI research ers and practitioners on three features as essential for identifying QI work more specifically as ‘ CQI . ’ All three features are needed as a minimum st and ard for recognizing CQI methods Abstract Problem : Inhabitants of Torres Strait Isl and s have the highest prevalence of diabetes in Australia and many preventable complications . In 1999 , a one year r and omised cluster trial showed improved diabetes care processes and reduced admissions to hospital when local indigenous health workers used registers , recall and reminder systems , and basic diabetes care plans , supported by a specialist outreach service . This study looked at whether those improvements were sustained two years after the end of the trial . Design : Three year follow up clinical audit of 21 primary healthcare centres , and review of admissions to hospital in the previous 12 months . Background and setting : Remote indigenous communities in far north east Australia , population about 9600 , including 921 people with diabetes . Key measures for improvement Number of people on registers , care processes ( regular measures of weight , blood pressure , haemoglobin A 1c , urinary protein concentration , and concentrations of serum lipids and creatinine ) , appropriate clinical interventions ( drug treatment and vaccinations ) , and intermediate patient outcome measures ( weight , blood pressure , and glycaemic control ) . Admissions to hospital . Strategies for change : Audit and feedback to clinicians and managers ; provision of clinical guidelines and a clear management structure ; workshops and training . Effects of change : The number of people on registers increased from 555 in 1999 to 921 in 2002 . Most care processes and clinical interventions improved . The proportion of people with good glycaemic control ( haemoglobin A 1c ≤ 7 % ) increased from 18 % to 25 % in line with increased use of insulin ( from 7 % to 16 % ) . The proportion of those with well controlled hypertension ( < 140/90 ) increased from 40 % to 64 % . The proportion admitted to hospital with a diabetes related condition fell from 25 % to 20 % . Mean weight increased from 87 kg to 91 kg . Lessons learnt : In remote setting s , appropriate management structures and clinical support for people with diabetes can lead to improvements in care processes , control of blood pressure , and preventable complications that result in admission to hospital . Control of weight and glycaemia are more difficult and requires more active community engagement . Priorities now include increasing the availability and affordability of good food , achieving weight loss , and increasing appropriate use of hypoglycaemic agents , including insulin OBJECTIVE : Outpatient asthma management remains suboptimal . We previously reported significant improvements in asthma guideline adherence and outcomes in children by using quality -improvement processes and community health workers . We hypothesized that a larger project could achieve comparable outcome improvements with streamlined quality -improvement processes and decreased technical assistance . METHODS : Seventeen clinics treating 12 000 children with asthma were evaluated through interviews of a subset of patients with persistent or high-risk asthma ( n = 761 ) at baseline and at 12 and 21 months and chart review s r and omly selected from all patients with asthma at baseline and 12 and 24 months ( n = 2040 ) . Multidisciplinary teams developed data -driven continuous quality -improvement activities . Asthma coordinators provided patient education and were active team members . RESULTS : Study children were predominantly Hispanic ( 77 % ) and black ( 11 % ) ; 60 % were enrolled in Medicaid , and 9 % were uninsured . Comparing results between baseline and the 21-month follow-up , significantly fewer families reported emergency-department visits ( 29.6 % vs 9.3 % ) , hospitalizations ( 10.9 % vs 3.4 % ) , frequent daytime symptoms ( 44.0 % vs 11.7 % ) , and missed school days ( 28.7 % vs 13.6 % ) ; significantly more reported confidence in asthma management ( 70.6 % vs 95.5 % ) ; and quality -of-life scores increased significantly for both children and caregivers ( all P < .05 ) . Cross-sectional data revealed significant clinic-wide improvements in symptom documentation , health care use , and review of action plans . CONCLUSIONS : On a larger scale , this approach realized impressive changes in provider clinical practice associated with major improvements in health outcomes . It holds great potential for significantly reducing asthma-related morbidity among low-income children Background Despite two decades of interventions , rates of sexually transmissible infections ( STI ) in remote Australian Aboriginal communities remain unacceptably high . Routine notifications data from 2011 indicate rates of chlamydia and gonorrhoea among Aboriginal people in remote setting s were 8 and 61 times higher respectively than in the non-Indigenous population . Methods / design STRIVE is a stepped-wedge cluster r and omised trial design ed to compare a sexual health quality improvement program ( SHQIP ) to usual STI clinical care delivered in remote primary health care services . The SHQIP is a multifaceted intervention comprising annual assessment s of sexual health service delivery , implementation of a sexual health action plan , six-monthly clinical service activity data reports , regular feedback meetings with a regional coordinator , training and financial incentive payments . The trial clusters comprise either a single community or several communities grouped together based on geographic proximity and cultural ties . The primary outcomes are : prevalence of chlamydia , gonorrhoea and trichomonas in Aboriginal residents aged 16–34 years , and performance in clinical management of STIs based on best practice indicators . STRIVE will be conducted over five years comprising one and a half years of trial initiation and community consultation , three years of trial conditions , and a half year of data analysis . The trial was initiated in 68 remote Aboriginal health services in the Northern Territory , Queensl and and Western Australia . Discussion STRIVE is the first cluster r and omised trial in STI care in remote Aboriginal health services . The trial will provide evidence to inform future culturally appropriate STI clinical care and control strategies in communities with high STI rates . Trial registration Australian and New Zeal and Clinical Trials Registry Background Relatively little is known about how  depression amongst people with chronic illness is identified and managed in diverse primary health care setting s. We evaluated the role of complex physical needs in influencing current practice of depression screening , documentation and antidepressant prescriptions during a 12-month period , among adults with Type 2 diabetes attending Aboriginal and Torres Strait Isl and er primary care health centres in Australia . Methods We analysed clinical audit data from 44 health centres participating in a continuous quality improvement initiative , using previously reported st and ard sampling and data extraction protocol s. Eligible patients were those with Type 2 diabetes with health centre attendance within the past 12 months . We compared current practice in depression screening , documentation and antidepressant prescription between patients with different disease severity and co-morbidity . We used r and om effects multiple logistic regression models to adjust for potential confounders and for clustering by health centre . Results Among the 1174 patients with diabetes included , median time since diagnosis was 7 years , 19 % of patients had a co-existing diagnosis of Ischaemic Heart Disease and 1/3 had renal disease . Some 70 % of patients had HbAc1>7.0 % ; 65 % had cholesterol > 4.0 mmol1 - 1 and 64 % had blood pressure>130/80 mmHg . Documentation of screening for depression and of diagnosed depression were low overall ( 5 % and 6 % respectively ) and lower for patients with renal disease ( Adjusted odds ratio [ AOR ] 0.21 ; 95 % confidence interval [ CI ] 0.14 to 0.31 and AOR 0.34 ; 95 % CI 0.15 to 0.75 ) , and for those with poorly controlled disease ( HbA1c>7.00 ( AOR 0.40 ; 95 % CI 0.23 to 0.68 and AOR 0.51 ; 95 % CI 0.30 to 84 ) ) . Screening for depression was lower for those on pharmaceutical treatment for glycaemic control compared to those not on such treatment . Antidepressant prescription was not associated with level of diabetes control or disease severity . Conclusions Background levels of depression screening and documentation were low overall and significantly lower for patients with greater disease severity . Strategies to improve depression care for vulnerable population s are urgently required . An important first step in the Australian Indigenous primary care context is to identify and address barriers to the use of current clinical guidelines for depression screening and care Background Early onset and high prevalence of chronic disease among Indigenous Australians call for action on prevention . However , there is deficiency of information on the extent to which preventive services are delivered in Indigenous communities . This study examined the variation in quality of preventive care for well adults attending Indigenous community health centres in Australia . Methods During 2005 - 2009 , clinical audits were conducted on a r and om sample ( stratified by age and sex ) of records of adults with no known chronic disease in 62 Indigenous community health centres in four Australian States/Territories ( sample size 1839 ) . Main outcome measures : i ) adherence to delivery of guideline -scheduled services within the previous 24 months , including basic measurements , laboratory investigations , oral health checks , and brief intervention on lifestyle modification ;  and ii ) follow-up of abnormal findings . Results Overall delivery of guideline -scheduled preventive services varied widely between health centres ( range 5 - 74 % ) . Documentation of abnormal blood pressure reading ( [ greater than or equal to]140/90 mmHg ) , proteinuria and abnormal blood glucose ( [ greater than or equal to]5.5 mmol/L ) was found to range between 0 and > 90 % at the 
    Output:
    
Barriers to implementing CQI  processes relate primarily to professional and organisational processes and operate at multiple levels ( individual , team , service , health system ) whereas barriers to improved care relate more directly to knowledge of best practice and team processes that facilitate appropriate care .