The FORGE AHEAD clinical readiness consultation tool: a validated tool to assess clinical readiness for chronic disease care mobilization in Canada’s First NationsReportar como inadecuado

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BMC Health Services Research

, 17:233

Quality, performance, safety and outcomes


BackgroundGiven the astounding rates of diabetes and related complications, and the barriers to providing care present in Indigenous communities in Canada, intervention strategies that take into account contextual factors such as readiness to mobilize are needed to maximize improvements and increase the likelihood of success and sustainment. As part of the national FORGE AHEAD Program, we sought to develop, test and validate a clinical readiness consultation tool aimed at assessing the readiness of clinical teams working on-reserve in First Nations communities to participate in quality improvement QI to enhance diabetes care in Canada.

MethodsA literature review was conducted to identify existing readiness tools. The ABCD – SAT was adapted using a consensus approach that emphasized a community-based participatory approach and prioritized the knowledge and wisdom held by community members. The tool was piloted with a group of 16 people from 7 provinces and 11 partnering communities to assess language use, clarity, relevance, format, and ease of completion using examples. Internal reliability analysis and convergence validity were conducted with data from 53 clinical team members from 11 First Nations communities 3–5 per community who have participated in the FORGE AHEAD program.

ResultsThe 27-page Clinical Readiness Consultation Tool CRCT consists of five main components, 21 sub-components, and 74 items that are aligned with the Expanded Chronic Care Model. Five-point Likert scale feedback from the pilot ranged from 3.25 to 4.5. Length of the tool was reported as a drawback but respondents noted that all the items were needed to provide a comprehensive picture of the healthcare system. Results for internal consistency showed that all sub-components except for two were within acceptable ranges 0.77–0.93. The Team Structure and Function sub-component scale had a moderately significant positive correlation with the validated Team Climate Inventory, r = 0.45, p < 0.05.

ConclusionsThe testing and validation of the FORGE AHEAD CRCT demonstrated that the tool is acceptable, valid and reliable. The CRCT has been successfully used to support the implementation of the FORGE AHEAD Program and the health services changes that partnering First Nations communities have designed and undertaken to improve diabetes care.

Trial registration numberCurrent protocol ID NCT02234973. Date of Registration: July 30, 2014

KeywordsReadiness Diabetes mellitus Quality improvement Chronic disease Indigenous First Nations AbbreviationsABCD - SATAudit and Best Practice for Chronic Disease – Systems Assessment Tool

ACICAssessment of chronic illness care

CRCTClinical readiness consultation tool

FORGE AHEADTransformation of Indigenous Primary Healthcare Delivery

QIQuality improvement

TCITeam climate inventory

TSFTeam Structure and Function sub-component of the CRCT

Electronic supplementary materialThe online version of this article doi:10.1186-s12913-017-2175-6 contains supplementary material, which is available to authorized users.

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Autor: Mariam Naqshbandi Hayward - Selam Mequanint - Jann Paquette-Warren - Ross Bailie - Alexandra Chirila - Roland Dyck - Michae


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