Practice Incentives Program Quality Improvement Measures: data update 2021-22

An accessible and high-quality primary care sector is the backbone of Australia’s health care system. General practitioners (GPs) are the first point of contact for most Australians seeking health care (RACGP 2020a), with 85% of the population seeing a GP in 2020–21 (AIHW 2022a). General practitioners are the most regularly accessed health professionals in Australia, and they are the frontline in the battle against emerging health conditions such as Coronavirus disease 2019 (COVID-19) (RACGP 2021).

In 2020-21, nationally, there were 171 million GP attendances claimed through Medicare, with a Level B consultation (lasting less than 20 minutes) the most common type of attendance (AIHW 2021a). The number of GP Medicare-subsidised services per person increased with age and was highest for those aged 80 and over (17.8 services per person). A lower proportion of those living in metropolitan Primary Health Network (PHN) areas had a Medicare-subsidised GP attendance (84%), compared with regional PHN areas (87%) (AIHW 2021a). Nearly half (45%) of Australians who needed to see a GP reported that they visited a GP four or more times during the year. Patient age and gender have an effect on the frequency of presentations, with females visiting their GP more than males, and older people visiting their GP more regularly than younger people (RACGP 2021).

The Practice Incentives Program (PIP) Quality Improvement (QI) Incentive is a payment to general practices for activities that support continuous data-driven quality improvement in patient outcomes and the delivery of best-practice care. General practices enrolled in the PIPQI Incentive commit to implementing continuous quality improvement activities that support them in their role of managing their patients’ health. They also commit to submitting nationally consistent, de-identified general practice data, against 10 key Improvement Measures that contribute to local, regional and national health outcomes (Department of Health 2019).

Purpose of the report

This is a data update on the 10 PIPQI measures. This report aims to provide nationally consistent, comparable data against specified measures that contribute to the assessment of needs, and to the improvement of regional and national health outcomes. The data, shared at the community level, and collected through the PIPQI Incentive, has the potential to inform primary health providers on how to improve care and services to clients and within a population. For example, this report may be used to assist the understanding of what proportion of a population within a region may benefit from preventative measures to ensure effective management of a specified chronic disease, such as diabetes. This can help delay progression of the condition, improve quality of life, increase life expectancy and decrease the need for high cost interventions.

The improvement measures are intended to support a regional and national understanding of chronic disease management in areas of high need, and are not designed to assess individual general practices or general practitioner performance. There are no set targets for the improvement measures.

The PIP Eligible Data Set

The de-identified data collected for the purposes of the PIPQI Incentive commenced on 1 August 2019, with participating general practices appointed as local data custodians, PHNs as regional data custodians, and the Australian Institute of Health and Welfare (AIHW) as the national data custodian of the PIPQI Eligible Data Set. For the specific roles and responsibilities of the local, regional and national data custodians please refer to the Data Governance Framework (Department of Health 2021). The Incentive focuses on health service events that have taken place against 10 Quality Improvement Measures (QIMs) and is a payment to general practices for activities that support data-driven continuous quality improvement in patient outcomes and the delivery of best-practice care (Department of Health 2020b).

PHNs enhance and connect primary health care within their region to achieve better health outcomes. Through their already established trust and working relationships with general practices, PHNs use the PIP Eligible Data Set to:

• work in partnership with local general practices to support quality improvement initiatives through reporting and feedback on managing general practice patient population, and
• perform needs assessments and plan service delivery at different levels, including PHN boundaries, local health districts, jurisdictional boundaries and at national level.

Data collection

The AIHW obtained Ethics Committee approval for the establishment of this data collection. As of July 2022, over 5,600 general practices across 31 PHNs contributed to the national aggregate PIPQI data.

As local data custodians, general practices participating in the PIPQI Incentive provide data on service counts against each measure to their regional PHN data custodian. Depending on the method of data submission used in the practices, the report is either generated by the practice’s clinical information systems or by the extraction of data from electronic medical records using a tool (Department of Health 2020b), and in accordance with the PIPQI Technical Specification v1.2 (Department of Health 2020c).

Data from clients who have opted-out in sharing de-identified data between practices and PHNs have not been extracted and therefore are not included in this report. A review commissioned by the Department of Health found that the data security controls in place during the collection, use and storage are appropriate to protect de-identified data from misuse, interference and loss (Department of Health 2020a).

Each PHN collates and aggregates PIPQI data extracts from general practices in accordance with the definitions of the 10 QIMs and aggregation and disaggregation permissions of the Data Governance Framework (p15, Table 1, Department of Health 2021). Some PHNs may choose to exclude an extract if it is not compatible with the PHN’s system or does not conform to the specifications. Aggregate data are then submitted to the AIHW on a quarterly basis, using a secure web-based data submission platform.

Upon receipt of the aggregate data, the AIHW applied a series of data validation rules to identify any data quality issues which were shared with relevant software vendors in March 2022. The data were compared with data from the previous period and other variance metrics. If the data did not meet any of the validation rules, the PHN was asked to either review their data and/or resupply and/or exclude some data. In this reporting period, 231 data extracts of poor quality from several vendors were excluded by almost all PHNs and AIHW from the reportable dataset. Inconsistencies and caveats are documented in the Technical notes.

After the regional data were validated, the AIHW compiled the data into a national data collection, and generated national estimates based on the supplied numerators and denominators for each cohort by age and sex (male and female) for each QIM. The proportions for each QIM are supplied in the Practice Incentives Program Quality Improvement Measures – Data Tables for download.

An annual survey sent by AIHW and completed by 31 PHNs, revealed that the primary clinical information systems used by practices to extract these data were Best Practice (61%), Medical Director (33%) and other (6%). It is important to note that due to the data supply from multiple different clinical information systems and extraction tools, there have been various interpretations of the technical specifications and coding of QIMs by individual vendors. AIHW observed differences in the aggregate data affecting multiple QIMs. For further description of general and QIM specific data quality and subsequent AIHW actions, please refer to the Technical notes.

Regular clients

PIPQI data submitted by PHNs only include ‘active’ or ‘regular’ clients – an individual who has visited a practice 3 or more times in the 2 years prior to the date of data extraction and whose service events were eligible for an MBS rebate. This is consistent with the RACGP definition of an active patient/client (RACGP 2010). Therefore, clients who visited a GP less than this amount are not included in this report. Note that those 3 visits could be at any time during the 2 years and do not necessarily mean that attendance at a practice has been recent.

Telehealth played a very important role in maintaining GP care during the COVID-19 pandemic (AIHW 2022b). Temporary telehealth MBS item numbers were made available from 13 March 2020 in response to the COVID-19 pandemic (Department of Health 2022). In 2020, 22% of GP visits were conducted via telehealth, and 20% in 2021 (AIHW 2022b). However, these temporary MBS items were not included in the scope of MBS items used to calculate the Standardised Whole Patient Equivalent (SWPE) for the purposes of payment calculations under the Practice Incentives program (PIP), including the payments for the PIP Quality Improvement Incentive, until January 2022 (Department of Health 2022).

This means that telehealth consultations received during this period were not counted towards the RACGP definition of a regular client (patient) who visited a particular primary health care provider three or more times in the last two years. Therefore, the actual aggregate QIM specific regular client cohort and proportions may be under-represented both nationally and in a PHN for that duration.

A range of public health interventions were put in place to help contain the spread of the virus that causes COVID-19. These included border controls; closure of non-essential businesses; work-from-home orders; school closures; density limits within businesses and workplaces; stay-at-home orders; mandated mask use; and test, trace, isolation and quarantine measures (AIHW 2022b). As many GPs and their patients used telehealth consults over face-to-face visits during the COVID-19 pandemic, there would have been fewer opportunities to take physical measures such as blood pressure, weight and height, and pathology testing thus impacting the overall regular client numbers for the related PIPQI measures. It is difficult to quantify the impacts of COVID-19 on the clients visiting general practices due to several factors including lockdowns, client health seeking behaviour, redistribution of practice resources, introduction and recalibration of telehealth consultations, service re-orientation to focus on provision of vaccination only and others (AIHW 2022b). A Digital Health Cooperative Research Centre and Macquarie University report from 800 general practices in select Victorian and NSW PHNs covering nearly 30% of the Australian population identified an increased uptake of telehealth services throughout the pandemic, which may reflect varied public health responses to the COVID-19 pandemic in those jurisdictions (Hardie et al. 2021). Readers of this report should take these factors into consideration when interpreting the findings.

As some clients actively attend more than one practice, including across more than one PHN region, the aggregated totals will report on these individuals more than once. For example, some people may attend one practice near their home or workplace while another near a holiday home. These totals do not represent the total resident population, or the total number of individuals who actively attend practices, or the prevalence of cohorts or conditions, or the percentage of the total population that attends practices. This may impact some PHN regions more than others due to the high prevalence of holiday homes.

There are differences in the types of visits that are counted towards the definition of a regular client across clinical software vendors and extraction tools which may impact the proportions reported for each QIM. The AIHW is collaborating with data extractors and software vendors to align the interpretation of the QIMs with the technical specifications.

Figures in this report should be interpreted with these caveats in mind. For further detail, please refer to the QIM specific caveats and footnotes within the Technical notes.

Interpreting PIPQI data

Results included in this report should be interpreted with care, taking into consideration the points raised above. In addition, it should be noted that this report provides information on a specific set of items for PIPQI and does not provide information around the entire care that is provided to a client.

Where data are presented as a time series, the results represent national point-in-time proportions of cohorts with a recorded result at each quarter.

This data should be interpreted in conjunction with other administrative and survey data collections where the data from these client-provider interactions are captured, for example, Medicare Benefits Schedule (MBS), the Australian Immunisation Register (AIR), the National Diabetes Service Scheme (NDSS) Register, the Australasian Paediatric Endocrine Groups (APEG) state and territory registers, and the National Cancer Screening Register (NCSR), the National Health Survey and State and Territory Health surveys.

For a full list of caveats and footnotes, please refer to the Technical notes.

PHN boundaries and residential population

In 2015, PHNs were established with the key objectives of increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care in the right place at the right time (Department of Health 2018). Where possible, boundaries of the PHNs align with Local Hospital Networks (LHNs) or equivalents, or cluster of LHNs, to facilitate collaborative working relationships and reduce duplication of effort. The analysis of data at a regional level allows for the planning, commissioning and provisioning of health services based on the local needs assessments of the community.

There are 31 PHNs that cover the whole of Australia and, in determining boundaries, a number of factors were taken into account, including diverse population size and future projected population growth, LHN alignment, State and Territory borders, patient flows and administrative efficiencies (Department of Health 2018).

PHNs vary considerably in geographical size and residential population at a community level (see further Department of Health 2021). In 2020, PHN population by usual residence varied from 61,572 to 1,928,927 people (ABS 2021). Some residents of PHNs may seek health services provided by other adjacent or non-adjacent PHNs. Across PHNs, the percentage of adults (>15 years of age) who saw a GP in the previous 12 months in 2019–20 varied from 78.6% to 87.1% (AIHW 2021b).

For estimated resident populations of PHNs, please refer to the supplementary data tables provided in the Practice Incentive Program Quality Improvement Measures - Data tables for download.