Impact of COVID-19

Analysis of the impact of COVID-19 on the activities and staffing of organisations reporting to the OSR and nKPI collections is complex because:

  • the data cover periods outside of the pandemic and cannot be disaggregated into those prior to and during the pandemic, for example:
    • the 2019–20 OSR collection covers the period 1 July 2019–30 June 2020, and only the months between March and June 2020 overlap with the pandemic
    • the June 2020 nKPI collection covers various periods, depending on the indicator, and uses the regular client definition (that is 3 visits within 2 years, noting some or all visits may have occurred before the pandemic)
  • some variation in results over time are normal.

However, by looking at the comments organisations include in the OSR to explain variations in their data (recorded for those with a 20% or more increase or decrease between periods), some analysis can be done on how often COVID-19 was cited as an explanation for variations in client numbers, client contacts, episodes of care, and FTEs.

To do this:

  • Because not all services submit OSR data every year, a dataset was created using the 196 organisations that reported in 2019–20 and refined to only include those organisations who also reported in each of the financial years 2017–18 and 2018–19. The resulting dataset contained 157 organisations.
  • The dataset was further reduced to 140 organisations to exclude organisations whose data was not considered comparable over the 3 periods. Reasons why data may not be comparable include changes to an organisation’s counting rules (for example, whether to include all clients of a large area health service or just a subset who use a particular service) or changes to clinical information systems (CIS).
  • Comments recorded for organisations with a 20% or more increase or decrease between 2019–20 and 2018–19 in client numbers, client contacts, episodes of care, and total FTEs were examined.

The aggregate data from the selected 140 organisations show increases in the number of clients and workforce between the two most recent periods and decreases in client contacts and episodes of care (Table 1).

Table 1. Change over time in key variables for selected organisations reporting to the OSR collection
 

2019–20

2018–19

2017–18

Number of clients

369,541

365,268

362,564

Client contacts (excluding transport)

4,311,447

4,388,859

4,342,268

Episodes of care

2,876,524

2,810,768

2,781,504

FTEs

5,853

5,697

5,737

Notes:

  1. N=140 organisations with no known data comparability issues across periods.
  2. Data comparability issues include changes of CIS, changes to inclusion/exclusion rules, data quality improvement efforts that mean previous time periods are not comparable.

Source: AIHW analysis of OSR data collection.

Aggregate analyses, however, can mask variations between organisations. Breaking the 2019–20 and 2018–19 data for the selected organisation down by whether there was a 20% or more decrease, a 20% or more increase or a less than 20% change shows that the numbers were relatively stable between periods for those organisations with a less than 20% change, but there were extensive changes for the other organisations (Table 2).

Table 2. Key variables for selected organisations reporting to the OSR collection, by degree of variation from previous reporting period, 2018–19 and 2019–20 (number)

2019–20

Degree of variation

Client numbers

Client contacts(a)

Episodes of care

Full-time equivalent (FTE) staff

<20% change

327,687

3,816,745

2,557,894

4,573

≥20% decrease

32,115

345,149

252,981

1,105

≥20% increase

9,739

149,553

65,649

175

Total

369,541

4,311,447

2,876,524

5,853

2018–19

Degree of variation

Client numbers

Client contacts(a)

Episodes of care

Full-time equivalent (FTE) staff

<20% change

327,485

3,826,736

2,531,145

4,567

≥20% decrease

24,379

257,481

187,536

845

≥20% increase

13,404

304,642

92,087

285

Total

365,268

4,388,859

2,810,768

5,697

  1. Excludes transport.

Notes:

  1. N=140 organisations with no known data comparability issues across periods.
  2. Degree of variation for 2018–19 refers to the change in numbers reported between 2017–18 and 2018–19; degree of variation for 2019–20 refers to the change in numbers reported between 2018–19 and 2019–20.
  3. Data comparability issues include changes of CIS, changes to inclusion/exclusion rules, data quality improvement efforts that mean previous time periods are not comparable.

Source: AIHW analysis of OSR data collection.

Looking at the number of organisations that explicitly cited COVID-19 as a reason for the variation in key characteristics between reporting periods shows that:

  • for client numbers:
    • of the organisations that reported a 20% or more decrease, the majority gave COVID-19 as the reason
    • of the organisations that reported a 20% or more increase, none gave COVID-19 as the reason
  • a similar pattern was observed for client contacts and episode of care but, of those that reported a 20% or more increase, 13% and 25%, respectively, gave COVID-19 as the reason, compared with 75% and 90% that reported a 20% or more decrease
  • very few organisations that reported a 20% or more increase or decrease in full-time equivalent (FTE) staff gave COVID-19 as the reason (Table 3).

Table 3. Number of selected organisations reporting to the OSR collection, by degree of variation from previous reporting period and reason, 2019–20

Client numbers

Citing COVID-19

Total organisations

≥20% decrease 

4

5

≥20% increase

11

<20% change

. .

124

Total

4

140

Client contacts

Citing COVID-19

Total organisations

≥20% decrease 

6

8

≥20% increase

2

15

<20% change

. .

117

Total

8

140

Episodes of care

Citing COVID-19

Total organisations

≥20% decrease 

9

10

≥20% increase

4

16

<20% change

. .

114

Total

13

140

Full-time equivalent (FTE) staff

Citing COVID-19

Total organisations

≥20% decrease 

2

13

≥20% increase

2

21

<20% change

. .

104

Total

4

138(a)

  1. Number of FTE was missing for 2 organisations.

Notes:

  1. N=140 organisations with no known data comparability issues across periods.
  2. Data comparability issues include changes of CIS, changes to inclusion/exclusion rules, data quality improvement efforts that mean previous time periods are not comparable.

Source: AIHW analysis of OSR data collection.

The organisations citing COVID-19 as an explanation for a decrease came from all remoteness areas, states and territories (with the exception of Western Australia), service sizes, and organisation types.

The reasons COVID-19 caused changes in the data are difficult to generalise but the explanations given by organisations included:

  • restrictions on travel for clients and staff
  • reluctance of some clients to attend during the pandemic or to use telehealth
  • difficulties in recording telehealth consultations
  • vulnerable staff working from home
  • people returning from urban areas to remote areas.

It is important to note, however, that these results are only indicative of the impact of COVID-19. Organisations whose data were not within the 20% threshold for variation may also have been affected but were not asked to provide an explanation.