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.'
affiliation: 'Yelland, J (Corresponding Author), Murdoch Childrens Res Inst, Hlth
  Mothers Hlth Families Res Grp, Parkville, Vic 3052, Australia.

  Yelland, Jane; Riggs, Elisha; Dawson, Wendy; Vanpraag, Dannielle; Brown, Stephanie,
  Murdoch Childrens Res Inst, Hlth Mothers Hlth Families Res Grp, Parkville, Vic 3052,
  Australia.

  Yelland, Jane; Riggs, Elisha; Furler, John; Brown, Stephanie, Univ Melbourne, Dept
  Gen Practice, Parkville, Vic 3052, Australia.

  Yelland, Jane; Riggs, Elisha, Univ Melbourne, Primary Hlth Care Acad Unit, Parkville,
  Vic 3052, Australia.

  Szwarc, Josef; Casey, Sue, Victorian Fdn Survivors Torture, Brunswick, Vic, Australia.

  East, Chris; Wallace, Euan, Monash Hlth, Monash Womens Matern Serv, Clayton, Vic,
  Australia.

  East, Chris; Biro, Mary Anne; Willey, Sue, Monash Univ, Sch Nursing \& Midwifery,
  Clayton, Vic, Australia.

  East, Chris; Wallace, Euan, Monash Univ, Ritchie Ctr, Clayton, Vic, Australia.

  Wallace, Euan, Monash Univ, Dept Obstet \& Gynaecol, Clayton, Vic 3168, Australia.

  Teale, Glyn, Western Hlth, Womens \& Childrens Serv, Sunshine, Vic, Australia.

  Teale, Glyn, Univ Melbourne, Dept Obstet \& Gynaecol, Parkville, Vic 3052, Australia.

  Harrison, Bernie, City Greater Dandenong, Maternal \& Child Hlth, Dandenong, Vic,
  Australia.

  Petschel, Pauline, City Wyndham, Maternal \& Child Hlth, Wyndham, Vic, Australia.

  Goldfeld, Sharon, Royal Childrens Hosp, Ctr Commun Child Hlth, Murdoch Childrens
  Res Inst, Parkville, Vic 3052, Australia.

  Goldfeld, Sharon; Mensah, Fiona, Univ Melbourne, Dept Paediat, Parkville, Vic 3052,
  Australia.

  Mensah, Fiona, Royal Childrens Hosp, Murdoch Childrens Res Inst, Clin Epidemiol
  \& Biostat Unit, Parkville, Vic 3052, Australia.

  Cheng, I-Hao, South Eastern Melbourne Medicare Local, Dandenong, Vic, Australia.

  Cheng, I-Hao, Monash Univ, Southern Acad Primary Care Res Unit, Clayton, Vic 3800,
  Australia.

  Small, Rhonda, La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia.

  Brown, Stephanie, Univ Melbourne, Sch Populat Hlth, Parkville, Vic 3052, Australia.'
article-number: '62'
author: Yelland, Jane and Riggs, Elisha and Szwarc, Josef and Casey, Sue and Dawson,
  Wendy and Vanpraag, Dannielle and East, Chris and Wallace, Euan and Teale, Glyn
  and Harrison, Bernie and Petschel, Pauline and Furler, John and Goldfeld, Sharon
  and Mensah, Fiona and Biro, Mary Anne and Willey, Sue and Cheng, I-Hao and Small,
  Rhonda and Brown, Stephanie
author-email: jane.yelland@mcri.edu.au
author_list:
- family: Yelland
  given: Jane
- family: Riggs
  given: Elisha
- family: Szwarc
  given: Josef
- family: Casey
  given: Sue
- family: Dawson
  given: Wendy
- family: Vanpraag
  given: Dannielle
- family: East
  given: Chris
- family: Wallace
  given: Euan
- family: Teale
  given: Glyn
- family: Harrison
  given: Bernie
- family: Petschel
  given: Pauline
- family: Furler
  given: John
- family: Goldfeld
  given: Sharon
- family: Mensah
  given: Fiona
- family: Biro
  given: Mary Anne
- family: Willey
  given: Sue
- family: Cheng
  given: I-Hao
- family: Small
  given: Rhonda
- family: Brown
  given: Stephanie
da: '2023-09-28'
doi: 10.1186/s13012-015-0251-z
files: []
issn: 1748-5908
journal: IMPLEMENTATION SCIENCE
keywords: 'Quality improvement; Partnerships; Universal health services; Refugee

  families; Time series design; Process evaluation'
keywords-plus: 'ANTENATAL CARE; SERVICES; WOMEN; BIRTH; REFLECTIONS; AUSTRALIA;

  DIFFUSION; COUNTRIES; FRAMEWORK'
language: English
month: APR 30
number-of-cited-references: '61'
orcid-numbers: 'Mensah, Fiona K/0000-0002-6951-9949

  Furler, John S/0000-0003-0339-5848

  Riggs, Elisha/0000-0003-0799-7467

  Wallace, Euan M/0000-0002-4506-5233

  East, Christine/0000-0002-1196-8426

  Willey, Suzanne/0000-0002-1314-0745

  Yelland, Jane/0000-0003-0377-5824

  Goldfeld, Sharon/0000-0001-6520-7094

  Brown, Stephanie/0000-0001-9812-0067

  Biro, Mary Anne/0000-0003-2000-8571

  Small, Rhonda/0000-0003-0345-4676'
papis_id: fbb510d2d0d2650475bd834d91300624
ref: Yelland2015bridginggap
researcherid-numbers: 'Mensah, Fiona K/G-3382-2018

  Brown, Stephanie/AAE-1662-2019

  Furler, John S/A-7858-2010

  Riggs, Elisha/K-4267-2019

  Wallace, Euan M/K-6774-2015

  East, Christine/H-4938-2013

  '
times-cited: '26'
title: 'Bridging the Gap: using an interrupted time series design to evaluate systems
  reform addressing refugee maternal and child health inequalities'
type: Article
unique-id: WOS:000354183000001
usage-count-last-180-days: '1'
usage-count-since-2013: '32'
volume: '10'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2015'