Interpreting nKPI data
This page contains general information to aid in interpreting nKPI data. Further information relevant to both collections is provided in the Technical notes.
Where to go for more information
This page contains general information to aid interpretation of nKPI data. This should be used in conjunction with additional information contained in the:
- data tables accompanying this report – see Data
- nKPI data collection information – see the nKPI data collection guide
- data quality statements for the nKPI collection – see Aboriginal and Torres Strait Islander specific primary health care key performance indicators (June 2023)
- Department of Health and Aged Care’s Health Data Portal.
The national Key Performance Indicators (nKPI) collection is a set of process-of-care and health-status indicators organised under 3 domains – maternal and child health, preventative health and chronic disease management (Table 1a to Table 1c). Some indicators consist of more than one measure (for example, an indicator might be collected by different types of chronic disease).
Process-of-care indicators | Health-status indicators |
|---|---|
PI13: First antenatal visit | PI02: Birthweight result |
PI01: Birthweight recorded | PI11: Smoking during pregnancy |
PI03: Health check – aged 0–14 |
|
Process-of-care indicators | Health-status indicators |
|---|---|
PI09: Smoking status recorded | PI10: Smoking status result |
PI16: Alcohol consumption recorded | PI12: Body Mass Index (BMI) |
PI03: Health check – aged 15 and over | PI21: CVD risk assessment result |
PI20: CVD risk assessment recorded |
|
PI22: Cervical screening |
|
PI14: Immunisation against influenza |
|
Process-of-care indicators | Health-status indicators |
|---|---|
PI07: Chronic Disease Management Plan – type 2 diabetes | PI24: Blood pressure result – type 2 diabetes |
PI23: Blood pressure recorded – type 2 diabetes | PI06: HbA1c result – type 2 diabetes |
PI05: HbA1c result recorded – type 2 diabetes | PI19: Kidney function test result (risk category) – type 2 diabetes and/or CVD |
PI18: Kidney function test type – type 2 diabetes and/or CVD |
|
Data are collected twice a year, with census dates at 30 June and 31 December. The period of data covered varies by indicator. For example, for the 30 June 2023 census date, the data covers, depending on the indicator:
- 6 months up to the census date, that is, from, 1 January 2023 to 30 June 2023, or
- 12 months up to the census date, that is, from 1 July 2022 to 30 June 2023, or
- 24 months up to the census date, that is, from 1 July 2021 to 30 June 2023, or
- 5 years up to the census date, that is, from 1 July 2018 to 30 June 2023 (for cervical screening only).
Process-of-care indicators are largely (but not completely) under the control of organisations and indicate good practice in primary health care. Health-status indicators, however, are influenced by a range of factors known as social determinants (such as education, employment, housing, access to resources, racism), some of which are beyond the immediate control of organisations. As such, the indicators need to be considered in context of the broader environment in which organisations operate and in which the data are collected. It is also important to acknowledge that the indicators capture only a subset of the important work that organisations do each day.
In this report, where there are small numbers of reporting organisations in a state or territory, data are presented combined with another state or territory. This is the case for Tasmania (presented combined with Victoria) and the Australian Capital Territory (presented combined with New South Wales).
Organisational participation and data exclusions
Not all organisations in-scope to report data to the nKPI collection do so. This varies by period (Table 2).
Collection period | In-scope to report data | Reported | Participation |
|---|---|---|---|
June 2017 | 228 | 228 | 100.0 |
December 2017 | 231 | 231 | 100.0 |
June 2018 | 236 | 233 | 98.7 |
December 2018 | 242 | 238 | 98.3 |
June 2019 | 240 | 234 | 97.5 |
December 2019 | 241 | 237 | 98.3 |
June 2020 | 236 | 220 | 93.2 |
December 2020 | 231 | 218 | 94.4 |
June 2021 | 232 | 215 | 92.7 |
December 2021 | 230 | 230 | 100.0 |
June 2022 | 230 | 230 | 100.0 |
December 2022 | 233 | 233 | 100.0 |
June 2023 | 233 | 233 | 100.0 |
For the organisations that do report data, particular data items may be excluded from analysis if data quality issues have not been resolved (Table 3). The major reasons for data not being provided or organisations having data quality problems include a lack of complete records of data held by the organisation, insufficient data management resources at organisations to support the data collection, organisations not providing the service for which the indicator collects information, and problems with the electronic transfer of data extracted from organisations’ clinical information system (CIS). Changes to the data extraction process were a major reason for organisations having data quality issues in their original submission from June 2017 to June 2018.
Collection period | Number of organisations with unresolved issues | Total number of organisations that reported data | Organisations with unresolved issues (%) |
|---|---|---|---|
June 2017 | 21 | 228 | 9.2 |
December 2017 | 25 | 231 | 10.8 |
June 2018 | 17 | 233 | 7.3 |
December 2018 | 2 | 238 | 0.8 |
June 2019(a) | — | 234 | — |
December 2019 | — | 237 | — |
June 2020 | 3 | 220 | 1.4 |
December 2020 | 6 | 218 | 2.8 |
June 2021 | 3 | 215 | 1.4 |
December 2021 | 17 | 230 | 7.4 |
June 2022 | 8 | 230 | 3.5 |
December 2022 | 6 | 233 | 2.6 |
June 2023 | 7 | 233 | 3.0 |
- June 2019 was the first collection period in which organisations were not required to provide data for indicators relating to a service they were not funded to provide, and to leave an indicator blank if they do not have the data for that indicator (for example because of a CIS issue).
In addition to unresolved internal validation issues, some indicators are excluded from analysis where the organisation’s data do not meet the regular client definition (for example because they were a new organisation or they had changed to a new CIS) or where issues were identified with a particular CIS. This varies by period and by data item. For example:
- Data from organisations using the MMEX CIS were excluded from data submitted in collections from June 2019 and earlier for indicators related to smoking and alcohol.
- PI13 (antenatal visits): data for some organisations using Communicare and Medical Director were affected by data extraction issues for June 2017, December 2017 and June 2018. This resulted in some categories being combined.
- PI20 (risk factors to enable a CVD risk assessment): MMEX results are excluded for June 2017.
- PI21 (CVD risk assessment result): data are only reportable from organisations with CIS which capture all data necessary to calculate a result (some CIS do not).
- PI22 (cervical screening): some data quality issues were identified with the initial June 2018 submission but these have been resolved for all other periods.
- PI18 and PI19 (kidney function test recorded and result) have had ongoing data quality issues since June 2017. Affected data were excluded.
Because of data exclusions, and because indicators may be applicable to different organisations (for example, maternal and child health organisations generally only report on maternal and child health indicators), the number of organisations contributing to results varies across indicators.
Changes to data extraction methods
Data from earlier collections are not comparable with data from June 2017 onwards. For the June 2017 collection, changes were made to the electronic data extraction method for most organisations that resulted in a break in series. For more information see AIHW 2018.
From December 2015 onwards, organisations funded by the Northern Territory Government changed the way in which data were extracted so that only tests or measurements conducted at the reporting organisation were counted.
Variations between CIS
There are variations between CIS and how each capture and extract results, in general and also between periods. For example:
- The PI09 smoking status recorded and PI10 smoking status result indicators specify that if a record does not have an assessment date assigned within the CIS, the record should be treated as current (that is, as having been updated within the previous 24 months). Whether the CIS capture all results or only those results updated within the previous 24 months varies between CIS. In particular, in June 2021, some CIS modified the inclusions for these indicators. The full impact of this has not been quantified but resulted in large decreases for some organisations between December 2020 and June 2021.
- In December 2021, the condition coding framework was introduced to align the codes used to define chronic diseases by the different CIS. Some CIS may have made changes to the condition codes for type 2 diabetes or CVD to bring their definition in line with the framework. This may have altered the number of clients included in PI05, PI06, PI07, PI18, PI19, PI20, PI21, PI23 and PI24.
Changes to indicators
Indicator specifications may be revised over time (for example, to reflect the latest clinical and best-practice guidelines). In particular, in 2020, in response to issues identified during the AIHW’s Review of the two national Indigenous specific primary health care datasets: OSR and nKPI, all indicators current as of June 2020 underwent a review by a clinical and technical working group sitting under, and convened by, the (First Nations) Health Services Data Advisory Group (HS DAG). As a result, HS DAG approved a series of changes to the indicators to be rolled out progressively during 2020–21.
Changes to indicators may impact interpretability of data over time (Table 4).
Indicator | Changes | Impact on time trends |
|---|---|---|
PI01 and PI02 (birthweight) | In June 2021, the definition for these indicators was adjusted to capture First Nations babies born in the previous 12 months who had more than one visit (previously included all First Nations babies born in the previous 12 months). In June 2021, multiple births were included in PI02 (previously these were only included in PI01). | Minimal |
PI03 (health check) | In December 2020, the age range captured by this indicator was expanded to include all ages (previously did not include ages 5–24); disaggregation by sex for ages 0–4 was added; and included MBS items were expanded (from only MBS Item 715) to contain: in-person MBS items 715 and 22; and telehealth MBS items 92004, 92016, 92011 and 92023. In June 2023, included MBS items were updated to remove item numbers 92016 and 92023 which were no longer valid. | For ages 0–14: data from December 2020 on cannot be compared with previous period for ages 5–14 or the total; ages 0–4 can be compared with caution. For ages 15 and over: data from December 2020 on cannot be compared with previous periods for ages 15–24 or the total; data for ages 25 and over can be compared with caution. |
PI04 (childhood immunisation) | After December 2020, this indicator was retired. | Data last collected in December 2020. |
PI07 (Chronic Disease Management Plan) | In December 2020, included MBS items were expanded (from only MBS Item 721) to contain: in-person MBS items 721 and 229; and telehealth MBS items 92024, 92068, 92055, and 92099. In June 2023, included MBS items were updated to remove item numbers 92068 and 92099 which were no longer valid. | Minimal |
PI08 (Team Care Arrangement) | After June 2020, this indicator was retired. | Data last collected in June 2020. |
PI09 and PI10 (smoking) | In June 2021, the age range captured by these indicators was expanded to include ages 11–14. | Data from June 2021 on cannot be compared with previous periods for the total. Data for ages 15 and over can be compared with caution. See also ‘Variations between CIS’. |
PI11 (smoking during pregnancy) | In June 2021, the definition of this indicator was adjusted to include only the latest smoking status recorded prior to the completion of the latest pregnancy (previously smoking status result was as recorded within the previous 12 months); and the lower age captured was expanded (age groupings changed to ‘less than 20’, ‘20–34’ and ’35 and older’ from ‘15–19’, ‘20–24’, ‘25–34’, and ’35 and older’). | Data from June 2021 on cannot be compared with previous periods for ages less than 20 or the total. Data for ages 20 and over can be compared with caution. |
PI12 Body Mass Index (BMI) | In December 2021, the age range captured by this indicator was expanded to include ages 18–24 (previously ages 25 and over); and additional BMI categories were added for ‘underweight (<18.50)’, ‘normal weight (18.50–24.99)’, and ‘not calculated’ (previously overweight and obese only). | Data from December 2021 on for the total cannot be compared with previous periods. Data for overweight and obese categories for ages 25 and over can be compared. |
PI13 (first antenatal visit) | In June 2021, grouping of gestational age at first visit changed to ‘before 11 weeks’, ‘11–13 weeks’, ‘14–19 weeks’ and ’20 weeks or later’ ‘did not have gestational age recorded’, and ‘did not attend an antenatal care visit’ (previously ‘less than 13 weeks’, ‘13–less than 20 weeks’, ’20 weeks or later’, ‘no result recorded’, and ‘did not attend an antenatal care visit’). | Data from June 2021 on for the total and some timing of visit categories cannot be compared with previous periods. Data on ’20 weeks or later’ can be compared. Data on whether or not there was antenatal care visit and whether or not gestational age was recorded at the first antenatal care visit can be compared with caution back to December 2018. |
PI14 (influenza immunisation) | In December 2020, the age range captured by this indicator was expanded to ages 6 months and over and age groups were added (previously ages 50 and over only with no further disaggregation by age). | Data from December 2020 on cannot be compared with previous periods. |
PI15 (influenza immunisation – type 2 diabetes and/or COPD) | After June 2021, this indicator was retired. | Data last collected in June 2021. |
PI17 (AUDIT-C) | After June 2022, this indicator was retired. | Data last collected in June 2022. |
PI18 (kidney function test type) | In December 2021, the age range for this indicator was expanded to be for all ages (previously ages 15 and over), the test types recorded were revised, and the client group 'type 2 diabetes and/or CVD' was added. From June 2022, the age range for this indicator was changed to ages 18 and over. | Data from June 2022 on for the total cannot be compared with previous periods. Data for ages 25 and over can be compared. |
PI19 (kidney function test result) | In December 2021 this indicator was not collected while modifications were made to its specifications. In June 2022, specifications for this indicator were adjusted to add the requirement for both an eGFR and an ACR result to be recorded, add a client group category for ‘type 2 diabetes and/or CVD’, revise the age range to ages 18 and over (previously ages 15 and over), and revise the kidney function test result categories. | Data from December 2021 cannot be compared with previous periods. Data from June 2022 on cannot be compared with previous periods. |
PI22 (cervical screening) | In June 2018 to June 2020 – transitional changes were made to align with revised requirements under the National Cervical Screening Program (NCSP). The key changes were to include clients who had either a Papanicolaou smear (Pap test) conducted prior to 1 December 2017 or a human papillomavirus (HPV test) conducted from 1 December 2017; revise the age range to 20–74 to accommodate the former reporting age range (20–69) and the new age range (25–74). In December 2020 – the indicator was revised to collect only HPV tests conducted in the last 5 years where the test occurred on or after 1 December 2017. | Interpret with caution, noting minimal impact if intent is to look at meeting cervical screening requirements over time. |
PI24 (blood pressure result) | In June 2021, the target blood pressure value was changed to ‘less than or equal to 140/90mmHg’ (previously ‘less than or equal to 130/80 mmHg’). | Data from June 2021 on cannot be compared with previous periods. |
Maternal and child health organisations
A small number of organisations that received funding only to provide maternal and child health programs or services (referred to as maternal and child health organisations) are included in the nKPI data presented in this report. This is because, while their funding is provided only for specific programs or services within a broader organisation rather than to the broader organisation itself, the maternal and child health indicators included in the nKPI collection apply directly to the maternal and child health organisations and the aims of the programs or services they are funded to deliver are considered similar to the aims of maternal and child health care delivered within other reporting organisations.
Since June 2019, maternal and child health organisations report only on maternal and child health indicators. Prior to June 2019, because these organisations were not limited to reporting only on maternal and child health indicators, a small number also reported against other indicators (like alcohol or BMI).
Reference
AIHW (Australian Institute of Health and Welfare) (2018) National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: results for 2017, National key performance indicators for Aboriginal and Torres Strait Islander primary health care series no. 5, Cat. no. IHW 200, AIHW, Australian Government, accessed 1 November 2023.