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Table 1 Summary of factors influencing performance of six remote Northern Territory health centres in delivering services to clients with acute rheumatic fever/rheumatic heart disease (ARF/RHD)

From: Improving delivery of secondary prophylaxis for rheumatic heart disease in remote Indigenous communities: study protocol for a stepped-wedge randomised trial

Determinants of relatively good performance Determinants of relatively poor performance
• Clear allocation of responsibility for rheumatic heart disease (RHD) care among health centre staff
• Good regional management – commitment to continuous quality improvement (CQI), resourcing for CQI
• Effective feedback and management action in response to feedback from CQI process
• Good Aboriginal health worker involvement in health centre operations
• Good outreach arrangements – including drivers, Aboriginal health workers
• Public health-oriented chronic disease support from regional level to health centres
• Staff stability and continuity, including availability of experienced general practitioner
• Client flows in health centres do not direct ARF/RHD clients to staff responsible for RHD care
• Lack of clear allocation of responsibility for RHD care
• Lack of effective outreach services
• Changes and inefficiencies in clinical information systems
• Lack of regular/stable staffing, including general practitioner service
• Health centre management turnover, unstable management structure
• Larger number of clients, complexities of urban environment