Aboriginal and Torres Strait Islander specific primary health care: results from the OSR and nKPI collections

For confidentiality reasons, data might not be published or might be presented with additional grouping of categories. For example, where there are small numbers of reporting organisations in a state or territory, data are sometimes presented combined with another state or territory, such as presenting the Australian Capital Territory combined with New South Wales.

Data collection and submission

Each organisation reporting to the OSR and nKPI collections records service provision in their clinical information systems (CIS). While CIS contain many variables related to individual clients, only those specified as required for the OSR and nKPI collections, aggregated for each organisation, are extracted for use.

Data are aggregated using cohort definitions and specialised software and then submitted via the Health Data Portal (the HDP). The HDP is the Department of Health, Disability and Ageing’s secure web-based data submission platform.

Most CIS used by organisations are able to extract, aggregate and upload the de-individualised data directly to the HDP through a direct-load process. Organisations with systems unable to complete the direct-load process can manually enter aggregate data directly into a web-based form through the HDP.

The HDP applies a series of pre-defined validation rules (originally developed by the AIHW) to the data to identify any data quality issues, for example, that the numerator is less than the denominator, that the numerator sums to the denominator and that related indicators or questions are consistent. In addition, the data are compared with data from the previous period and:

• for the OSR collection, differences of more than 20% are flagged
• for the nKPI collection, differences of 25% to 100% are flagged, depending on the size of the numerator/denominator.

If any validation rules are triggered, the organisation is asked to review their data and either amend it, or confirm that it is correct and provide a comment.

The data are then submitted to the AIHW for review. Where the AIHW identifies possible errors or inconsistencies in the data, a comment is added to the HDP containing a description of the issue and the organisation is invited to resubmit their data. This process is repeated until no data quality issues are identified, the relevant organisation indicates it is unable or unwilling to resupply corrected data or the collection period is closed. At this point, the data are considered to be finalised for that organisation.

Where unresolved data quality issues are identified, the AIHW excludes these data from national reporting (this may be a single data item for an organisation or all data for an organisation).

Organisations reporting to each collection

Most organisations contribute to both the OSR and nKPI collections (Table 2).

1. Refers to the June collection period for the nKPI and the financial year collection period for the OSR.
2. Includes organisations receiving primary health care funding that only report on maternal and child health indicators.
3. Organisations that received funding only to provide maternal and child health programs or services. OSR data presented in this report exclude these organisations unless otherwise noted. For more information see Interpreting OSR data and Interpreting nKPI data. For selected OSR data from these organisations see Data.
4. Reporting to the collections for these periods was made voluntary in acknowledgement of the additional pressures on organisations because of COVID-19.

Note: For more information, including on interpreting changes over time, see Comparisons over time.

Source: OSR and nKPI data collections.

While some organisations constitute an individual health care clinic, others have multiple clinics, and provide combined data for all their clinics. Other organisations are intermediaries (for example, Primary Health Networks), which might also combine the data for the clinics where they subcontract services.

Aboriginal Community Controlled Health Organisations (ACCHOs) report all activity (regardless of funding source). Non-ACCHOs should only report activity funded under the Indigenous Australians' Health Programme (IAHP) but some report all activity. The extent to which this occurs is not known and may vary by period.

Exclusion of maternal and child health organisations from OSR data

In this report, unless otherwise noted, data from the small number of organisations that received funding only to provide maternal and child health programs or services are included in nKPI data but are excluded from OSR data. These organisations should report only on funded activity and are primarily non-ACCHOs. For more information see Interpreting OSR data and Interpreting nKPI data.

Clients

A person is counted as a client once only within an organisation, regardless of how many times they are seen. A client, however, may attend more than one organisation. The extent to which this occurs is not known and is not adjusted for. Clients included in each collection differ:

• OSR – contains 3 measures related to the clients that organisations see – client numbers, client contacts and episodes of care. Organisations reporting to the OSR collection may see a mix of First Nations and non-Indigenous clients.
  Data for both First Nations and non-Indigenous clients are included (that is, not all clients included in the OSR collection are regular clients). Visitors and transient clients are included, but clients attending group activities only (and who do not receive individual care) are excluded. Deceased clients who were seen during the reference period are included.
• nKPI – organisations reporting to the nKPI collection may see a mix of First Nations and non-Indigenous clients. Some of these are considered regular clients of the organisation. For the purposes of the nKPI collection, with the exception of 2 indicators on birthweight, indicators include only First Nations regular clients. This is defined as a First Nations person who attended a particular primary health care organisation at least 3 times in the previous 2 years. The 2 indicators related to birthweight are for First Nations babies that have attended the organisation more than once in the previous 12 months.
  Deceased clients are excluded.
  Indicators that are collected by sex and age only include records where age and sex were recorded. A count of the overall number of First Nations regular clients (without a sex or age recorded, with a sex recorded but not an age, with an age recorded but not a sex, and with both a sex and age recorded) is also collected.

Comparisons over time

Data and trends over time are presented where possible, noting that the organisations reporting to the OSR and nKPI collections, and data quality, can vary over time. For example:

• While for the most part, it is the same organisations contributing to the collections, as a result of changes in funding, auspicing or reporting arrangements at the local level:
  • the organisations that are funded to provide services vary between periods
  • the funded organisations that are in-scope to report data vary between periods, for example, an organisation may be given an exemption from reporting for a specific period(s).
• Some organisations may be unable to report accurate data in particular periods or for particular data items (for example, because of changes in their CIS or record-keeping practices) and these data are excluded from national reporting. As such, the number of organisations submitting valid data, on the whole or for a particular data item, vary between periods.
• There have been changes to specifications over time, for example as a result of revisions to relevant clinical or best practice guidelines.
• The COVID-19 pandemic and associated emergency response measures affected the organisations reporting to the collections, and the resulting data, in a variety of ways.

In March 2020, the World Health Organization declared COVID‑19 to be a pandemic and Australia entered a period of emergency response measures. In April 2022, the Human Biosecurity Emergency Declaration under the Biosecurity Act lapsed and the COVID-19 pandemic emergency response started winding down.

In addition, during the peak of the emergency response, in acknowledgement of the additional pressures on organisations because of COVID-19, reporting to the collections was made voluntary for the:

• 2019–20 and 2020–21 OSR collection periods
• June 2020, December 2021 and June 2021 collection periods.

This affected the number and type of organisations providing data during those periods.

As COVID-19 associated emergency response measures had largely wound down by the end of 2022, and reporting to the collection had returned to mandatory reporting, OSR collection data from 2022–23 are considered less affected than those in 2019–20, 2020–21 and 2021–22; and December 2022 was chosen as the start point for trends for the nKPI collection.

These breaks, however, are not clean breaks. For example:

• While reporting to the 2019–20 OSR collection period was made voluntary, only part of this period was affected by COVID-19 and related emergency response measures, and the 2022–23 and 2023–24 OSR collection periods, in particular, may include varying amounts of time overlapping with, and potentially impacted by, the emergency response measures.
• Each indicator in the nKPI collection has an assigned time frame (reference period) as part of its specification and these vary between indicators – that is, depending on the indicator, data are collected at a census date (30 June or 31 December) for either the previous 6 months, 12 months, 24 months or 5 years. As such, data in the December 2022 collection period still include varying amounts of time overlapping with, and potentially impacted by, COVID-19 and associated emergency response measures. For example, for the 31 December 2022 census date, the data cover, depending on the indicator:
  • 6 months up to the census date, that is, from, 1 July 2022 to 31 December 2022
  • 12 months up to the census date, that is, from 1 January 2022 to 31 December 2022
  • 24 months up to the census date, that is, from 1 January 2021 to 31 December 2022
  • 5 years up to the census date, that is, from 1 January 2018 to 31 December 2022.

For more information on the impact of COVID-19 on selected OSR and nKPI data items, see Related material.

The linear trend lines in the data visualisations provide a general impression of the direction of the data. Caution should be taken interpreting trends with less than 5 data points. P-values were used to test the statistical significance of selected nKPI trends.

See also the Data Quality Statements for each collection in METEOR.

Estimated resident population

The estimated resident population (ERP) used as comparison for the OSR and nKPI client cohorts varies. The ERP chosen, or calculated, for each period is determined based on what is considered to be the most representative population for that period.

As the nKPI collection is based on census dates at 30 June and 31 December each year, the most appropriate ERP to use for comparison with First Nations regular clients is the ERP at the same date as the census date.

As the OSR collection covers a financial year, and estimates as at 30 June not considered appropriate for use when calculating rates based on financial year data, estimates for 31 December (that is, the midpoint of the financial year) are needed.

While the Australian Bureau of Statistics (ABS) produces estimates for the overall Australian population for 2 time points each year – namely, as at 30 June and 31 December – they only produce estimates for the First Nations population as at 30 June. As such, ERP at 31 December are calculated by averaging the June population estimates before and after the relevant December. For example, 31 December 2020 estimate = (30 June 2020 estimate + 30 June 2021 estimate)/2.

Rounding

Numbers presented in tables and visualisations are unrounded.

Averages and proportions presented in text, tables and visualisations are rounded to one decimal place.

The number of organisations presented in text are unrounded. All other numbers presented in text are rounded, according to the following rules:

• millions are rounded to one decimal place and written with a number and a word, for example, 10.2 million
• numbers over 100,000 and under one million are rounded to the nearest multiple of 1,000
• numbers between 1,000 and 100,000 are rounded to the nearest multiple of 100
• numbers between 500 and 999 are rounded to the nearest multiple of 10
• numbers between 100 and 499 are rounded to the nearest multiple of 5
• numbers between 0 and 99 are rounded to the nearest whole number.