Technical notes

General caveats and footnotes

  1. The PIP Eligible Data Set is based upon the RACGP definition of a regular/active client who has visited a practice 3 or more times in the 2 years prior to the date of data extraction.

    Note, that a regular client does not necessarily mean that the client’s attendance at a practice has been recent. There may be a clustering of client visits to practices based around health service events. As some clients actively attend more than one practice, or the same practice more than once, including across more than one PHN region, these aggregated health service events may represent clients more than once.

    Each QIM is only indicative of a cross section of regular clients that meet the inclusion criteria for each measure. It does not represent the total resident population, the total number of individuals who actively attended practices, the prevalence of cohorts or conditions, or the percentage of total population that attend practices.

  2. As outlined in the Practice Incentives Program Quality Improvement Incentive Quality Improvement Measures User Guide for General Practices (Department of Health 2020b), for calculating each Quality Improvement Measure, visits are only considered if they are eligible for an MBS rebate including clients visiting one or more providers in that practice. If more than one visit occurs on the same day, these are counted towards the 3 visits.

    Non-clinical events, such as administration and client notification activities are not counted as visits in this report. Clients who are deceased are excluded from the report.

    A known limitation of some clinical information systems is the inability to distinguish clinical and non-clinical visits (such as notes made in the client record) for the purposes of this report.

    The capture of some data may be affected by the manual coding of diagnoses from free text data fields, and the sensitivity and specificity of the capture may vary with the accuracy of the manual input into a clinical information system.

  3. Temporary telehealth MBS item numbers were made available from 13 March 2020 in response to the COVID-19 pandemic. These temporary MBS items were not included in the scope of MBS items used to calculate the SWPE for the purposes of payment calculations under the Practice Incentives Program (PIP) until January 2022. This includes payments for the PIP Quality Improvement Incentive (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 3 or more times in the last 2 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.

    PHNs that used the POLAR extraction tool resupplied data from January 2022 that included recalibration of telehealth MBS item numbers into the count of RACGP regular clients.

    As many GPs and their patients preferred 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 thus impacting the overall regular client numbers for the related PIPQI measures. Readers of this report should take these factors into consideration when interpreting the findings.
  4. Aggregate data for the 10 Improvement Measures are supplied on a quarterly basis from PHNs to the AIHW as outlined in the PIPQI Improvement Measures – Technical Specification (Department of Health 2020c).
  5. For instances where the PHN observes data quality issues with practice submissions, or the practice is not compatible with the PHN system, the PHN will exclude these practice submissions from the aggregate PIPQI file that is shared with the AIHW.
  6. The capture of some data may be reflected differently across PHNs due to the operation of different extraction tool and CIS vendors in use. In turn this has resulted in different interpretations of the QIMs and the associated coding.
  7. Results arising from measurements conducted outside of the service that are known and recorded in the GP record are included.
  8. The AIHW is continuously working with extraction and CIS vendors to improve the quality of the PIPQI data. Therefore, at various points in time, there may be resupplies of the data and this may not be reflected in the historical reports.
Quality Improvement Measure specific caveats and footnotes
QIM Caveats and footnotes

QIM 1

Diabetes: Proportion of regular clients with diabetes with an HbA1c result
  • A client is classified as having diabetes for this measure, if they have Type 1 or Type 2 or undefined diabetes as a diagnosis in their GP record.
  • Clinical definitions for diabetes vary across clinical information systems, as different coding schemes are used. This may lead to some variation in the number of clients who will be picked up by different systems (Department of Health 2017).
  • Any clients who had gestational diabetes but also have Type 1 or 2 diabetes are included in the measure.
  • Multidisciplinary care delivered by multiple providers are often required to safely manage patients with diabetes and its complications. For example, younger patients and patients with Type 1 diabetes are more likely to receive shared care from specialist services. Missing information on HbA1c for these patients could relate to the information not being shared electronically between the specialist services and general practices.
  • Results arising from measurements conducted outside of the service that are known and recorded in the GP record are included.
  • Clients are excluded from the measure if they:
    • had secondary diabetes, gestational diabetes mellitus (GDM), previous GDM, impaired fasting glucose, impaired glucose tolerance,
    • had results from measurements conducted outside of the service which were not available to the service and had not visited the service in the previous 12 months.
  • There are other administrative data collections where the data from these client-provider interactions are captured for example, Medicare Benefits Schedule (MBS), the National Diabetes Service Scheme (NDSS) register, the Australasian Paediatric Endocrine Groups (APEG) state and territory registers.

QIM 02a

Smoking: Proportion of regular clients whose smoking status has been recorded
  • Clients aged between 15 and 29.999 years of age are included if their smoking status has been recorded within the past 12 months.
  • Clients aged 30 years and over are included if their smoking status has been recorded at least once since turning 30.
  • Results arising from measurements conducted outside of the service that are known and recorded in the GP record are included.

QIM 02b

Smoking: Proportion of regular clients with a smoking status result
  • Includes only those clients with a smoking status recorded as defined in the numerator of QIM 02a. 
  • Results of “Daily smoker”, “weekly smoker” and “irregular smoker” are aggregated into “Current smoker”.
  • The most recently recorded result is included in the measure, which are
    • Clients aged between 15 and 29.999 years of age are included if their smoking status has been recorded within the past 12 months.
    • Clients aged 30 years and over are included if their smoking status has been recorded at least once since turning 30. 

QIM 03a

BMI: Proportion of regular clients with a height and weight measurement record
  • Clients aged between 15 and 24.999 years are included if both the height and weight measurement have been recorded in the previous 12 months.
  • Clients aged 25 years and over are included if height has been recorded since the client turned 25 years of age and a weight has been recorded within the previous 12 months.
  • Results arising from measurements conducted outside of the service that are known and recorded by the service are included in the measure.

QIM 03b

BMI: Proportion of regular clients with a derived BMI result
  • Includes only those clients with a record of weight classification derived from a record of height and weight as defined in the numerator of QIM 03a. 
  • If the client had their BMI recorded more than once within the previous 12 months, only the most recently recorded result is included in this measure.
  • Clients are excluded from the measure if they are 18 or older and either shorter than 0.914 or taller than 2.108 metres; or refused measurement.
  • AIHW has been working with all vendors towards a consistent approach to the data specification interpretation, ensuring all interpretations are consistent. Due to the uneven exclusion criteria across QIM 03a and QIM 03b, not all extraction vendors excluded very tall or very short people from QIM 03b in line with the technical specifications.
  • From January 2022 onwards, 27 PHNs using CAT4 re-submitted data which resolved these data inconsistencies with QIM 03.   

QIM 04

Influenza 65 years: Proportion of regular clients aged 65 and over who were immunised against influenza
  • Data for clients aged 65 and over are included if the client has been immunised against influenza within the previous 15 months.
  • Results arising from clinical intervention conducted outside of the service that are known and recorded by the service are included in the measure. Where immunisation was given elsewhere (for example, workplace or pharmacy) and the information is not recorded in the electronic record of the client’s usual general practice, then this may result in an apparent missing information.  
  • Clients are excluded from the measure if they:
    • did not have the immunisation due to documented medical reasons (e.g. allergy), system reasons (vaccine not available), or client reasons (e.g. refusal); or
    • had results from measurements conducted outside of the service which were not available to the service.
  • There are other administrative data collections where the data on influenza immunisation are captured for example, the Australian Immunisation Register (AIR).  
  • There was change in the recording of influenza immunisations identified in January 2022 that resulted in an undercount of the number of regular clients receiving influenza immunisations and a lower proportion reported for this QIM (Pen CS, 2022). This change impacted the January 2022 and April 2022 data submissions for selected practices in 27 of the 31 PHNs.

QIM 05

Influenza Diabetes: Proportion of regular clients with diabetes who were immunised against influenza
  • Data for clients with diabetes are included if they have received an influenza vaccine within the previous 15 months.
  • Clinical definitions for diabetes vary across clinical information systems, as different coding schemes are used. This may lead to some variation in the number of clients who will be picked up by different systems (Department of Health 2017).
  • Results arising from clinical intervention conducted outside of the service that are known and recorded by the service are included in the measure. Where immunisation was given elsewhere (for example, workplace or pharmacy) and the information is not recorded in the electronic record of the client’s usual general practice, then this may result in an apparent missing information.  
  • A client is classified as having diabetes, if they have Type 1 or Type 2 diabetes, or a diagnosis which indicates diabetes but does not specify between Type 1 or Type 2, listed as a diagnosis in their GP record. If a client had gestational diabetes but also has Type 1 or Type 2 diabetes, they are included in the measure.
  • Clients are excluded from the measure if they:
    • did not have the immunisation due to documented medical reasons (e.g. allergy), system reasons (vaccine not available) or client reasons (e.g. refusal),
    • had secondary diabetes, gestational diabetes mellitus (GDM), previous GDM, impaired fasting glucose, impaired glucose tolerance,
    • had results from measurements conducted outside of the service which were not available to the service.
  • There are other administrative data collections where the data on influenza immunisation are captured for example, the Australian Immunisation Register (AIR).  
  • There was change in the recording of influenza immunisations identified in January 2022 that resulted in an undercount of the number of regular clients receiving influenza immunisations and a lower proportion reported for this QIM (Pen CS, 2022). This change impacted the January 2022 and April 2022 data submissions for selected practices in 27 of the 31 PHNs.

QIM 06

Influenza COPD: Proportion of regular clients with COPD who were immunised against influenza
  • Chronic Obstructive Pulmonary Disease (COPD) includes any diagnosis of COPD.
  • Clinical definitions for COPD vary across clinical information systems, as different coding schemes are used. This may lead to some variation in the number of clients who will be picked up by different systems (Department of Health 2017).
  • Data for clients are included if they have received an influenza vaccine within the previous 15 months.
  • Results arising from clinical intervention conducted outside of the service that are known and recorded by the service are included in the measure. Where immunisation was given elsewhere (for example, workplace or pharmacy) and the information is not recorded in the electronic record of the client’s usual general practice, then this may result in an apparent missing information.  
  • Clients are excluded from the measure if they:
    • did not have the immunisation due to documented medical reasons (e.g. allergy), system reasons (vaccine not available) or client reasons (e.g. refusal),
    • had results from measurements conducted outside of the service which were not available to the service.
  • There are other administrative data collections where the data on influenza immunisation are captured for example, the Australian Immunisation Register (AIR).
  • There was change in the recording of influenza immunisations identified in January 2022 that resulted in an undercount of the number of regular clients receiving influenza immunisations and a lower proportion reported for this QIM (Pen CS, 2022). This change impacted the January 2022 and April 2022 data submissions for selected practices in 27 of the 31 PHNs.

QIM 07

Alcohol: Proportion of regular clients with an alcohol consumption status record
  • Includes in the numerator only those clients aged 15 years and over with an alcohol consumption status ever recorded in their GP record. There is currently no reference period of recording the client status applied for this QIM within the technical specification documents.
  • Data on alcohol consumption results (frequency and dose) are not captured in this measure.

QIM 08

CVD: Proportion of regular clients with the necessary risk factors recorded to enable CVD risk assessment
  • Data for clients are included if they have record of necessary risk factors (age, sex, tobacco smoking status, diabetes type or HbA1c result or fasting glucose tests, blood pressure, lipid levels) to assess CVD risk assessment.
  • Clinical definitions for CVD vary across clinical information systems, as different coding schemes are used. This may lead to some variation in the number of clients who will be picked up by different systems (Department of Health 2017).
  • The reference periods for recording the risk factors of this QIM have been interpreted and coded differently by different extraction tool vendors. The POLAR extraction tool used by 5 PHNs, applied reference period cut-off dates of 24 months for recording systolic blood pressure and 5 years for recording cholesterol/HDL levels, in line with the RACGP Red Book (RACGP 2018). In contrast, the CAT4 extraction tool used by 27 PHNs, did not apply any reference period cut-off dates for diabetes screening, systolic blood pressure, cholesterol/HDL levels. For this reason these results should be interpreted with caution when comparing results between extraction tools.  
  • Eligible clients who do not have a current diagnosis of a cardiovascular condition and have a record of age, sex, tobacco smoking status, systolic blood pressure, diabetes status/diabetes screening test, total cholesterol and HDL cholesterol levels in their GP record are included in the measure.  
  • Clients are excluded from the measure if they
    • refused measurement,
    • have a recorded diagnosis of CVD, are regular and without known CVD, but information for ALL risk factors is not recorded. 

QIM 09

Cervical: Proportion of regular female clients with an up-to-date cervical screening test record
  • Data are reported quarterly for services delivered in the given period (5 years).
  • A small minority of data from Pap smear tests conducted prior to 1 December 2017 may be included in this report.
  • Results arising from clinical intervention conducted outside of the service that are known and recorded by the service are included in the measure.
  • Clients who had a sub-total hysterectomy are included in the measure.
  • HPV tests where the sample is either collected by a health practitioner or self-collected are included.
  • Clients are excluded from the measure if they:
    • had a complete hysterectomy,
    • did not have the test due to documented medical reasons, system reasons (test not available), or client reasons (e.g. refusal),
    • had results from measurements conducted outside of the service which were not available to the service, or
    • no longer require testing.
  • There are other administrative data collections where the data on cervical screening test are captured for example, the National Cancer Screening Register (NCSR).

QIM 10

Diabetes Blood Pressure: Proportion of regular clients with diabetes with blood pressure recorded
  • Clinical definitions for diabetes vary across clinical information systems, as different coding schemes are used. This may lead to some variation in the number of clients who will be picked up by different systems (Department of Health 2017).
  • Results arising from measurements conducted outside of the service that are known and recorded by the service are included in the measure.
  • A client is classified as having Type 1 or Type 2 diabetes, or a diagnosis which indicates diabetes but does not specify between Type 1 or Type 2, listed as a diagnosis in their GP record. If a client had gestational diabetes but also has Type 1 or Type 2 diabetes, they are included in the measure.
  • Clients are excluded from the measure if they had:
    • secondary diabetes, gestational diabetes mellitus (GDM), previous GDM, impaired fasting glucose, impaired glucose tolerance,
    • results from measurements conducted outside of the service that were not available to the service; and had not visited the service in the previous 6 months.
  • There are other administrative data collections where the data from these client-provider interactions are captured for example, Medicare Benefits Schedule (MBS), the National Diabetes Service Scheme (NDSS) register, the Australasian Paediatric Endocrine Groups (APEG) state and territory registers.

 

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