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

The 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).

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).

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.

^(a) 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). See also Changes to indicators.
• 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 National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: results for 2017 (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 clinical information system

There are variations between clinical information system (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).

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.