Practice Incentives Program Quality Improvement Measures: annual data update 2023–24

Introduction

Introduction

An accessible and high-quality primary care sector is integral to Australia’s health care system. General practitioners (GPs) are the first point of contact for most Australians seeking health care (RACGP 2020a). In 2022-23, 86% of the population consulted GPs, underscoring their key role in health care delivery (AIHW 2024a). GPs continue to be the most common health professionals seen in Australia (ABS 2023a), with most clients reporting positive experiences (RACGP 2023). In 2022-23, nationally, there were 166 million GP attendances claimed through Medicare, with a Level B consultation (lasting less than 20 minutes) the most common type of attendance (AIHW 2024a). 

The Practice Incentives Program (PIP) Quality Improvement (QI) Incentive is a payment to general practices for activities to 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).

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 be prevalence measures, or assess individual general practices or general practitioner performance. There are no set targets for the improvement measures.

The ten measures are:

• Proportion of regular clients with diabetes with a current HbA1c result; QIM 1
• Proportion of regular clients with a smoking status; QIM 2
• Proportion of regular clients with a height and weight measurement record, and a derived BMI result; QIM 3
• Proportion of regular clients aged 65 and over who were immunised against influenza; QIM 4
• Proportion of regular clients with diabetes who were immunised against influenza; QIM 5
• Proportion of regular clients with COPD who were immunised against influenza; QIM 6
• Proportion of regular clients with an alcohol consumption status; QIM 7
• Proportion of regular clients with the necessary risk factors recorded to enable CVD risk assessment; QIM 8
• Proportion of regular female clients with an up-to-date cervical screening; QIM 9
• Proportion of regular clients with diabetes with blood pressure recorded; QIM 10

Purpose of the report

This is an annual data update on the 10 Quality Improvement Measures (QIMs). 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. These data, shared at the community level, and collected through the PIPQI Incentive, have the potential to inform primary health care providers on where care and services may be improved for clients, and within a population. For example, this report may be used to understand 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 PIP Eligible Data Set

Each PHN collated and aggregated PIPQI data extracts from general practices in accordance with the definitions of the 10 QIMs from clients who 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.  

The health data ecosystem relies on high quality ‘electronic health records’ (EHRs) that play a crucial role in improving the provision of health care services and patient outcomes (AIHW 2024b). In Australia, general practices use various data management systems such as Clinical Information Systems (CISs) and extraction tools developed by different software providers to manage patient EHRs. The CISs are used by practices to electronically record administrative and clinical information. Extraction tools are developed by software providers to access de-identified data from CISs and generate reports to assist practices and PHNs with clinical audits, quality improvement activities, and research activities (RACGP 2020b). Figure 1 shows that the most commonly used CISs were Best Practice (69.1%) and Medical Director (27.3%, including MD Clinical/Insights and Helix combined), followed by other software providers combined (3.6%). Between July 2023 and July 2024, the number and proportion of PIPQI data submitting practices using Best Practice software increased from 3,874 (65.8%) to 4,135 (69.1%).

Figure 1: Proportion of PIPQI practices, by Clinical Information System software provider, July 2024

With the implementation and use of a third extraction tool during 2023-24, we observe consequentially a greater diversity of data files within the PIPQI data ecosystem. While the total number of data submitting practices this reporting period was similar to the previous period, there was a decrease in the proportion of these practices relying on direct extraction (5,554, 93.9% compared to 5,565, 92.9%) and a concomitant increase of 17.2% (from 361 to 423) in the number of practices submitting their data as ‘JSON files’ (Figure 2, see Technical notes - PIP Eligible Data Set). With the further adoption of the Primary Sense extraction tool by PHNs in future months, we anticipate that there will be further diversification of data files and software versions.

Figure 2: Proportion of PIPQI practices, by PHN and submission pathway, July 2024

In July 2024, there were 5,988 practices that submitted PIPQI data. Of these, 14 data submissions across 7 PHNs that were generated by an extraction tool were excluded for reporting purposes due to technical issues (out of 5,565 practices submitting directly extracted data). Operating outside of extraction tools, there were also 411 out of 423 ‘JSON files’ (see Technical notes - PIP Eligible Data Set) submitted that were excluded for reporting purposes due to ongoing data quality issues affecting multiple QIMs. Of the 411 JSON files with data quality issues, 276 were from practices using Best Practice, 86 using Medical Director, and 49 using other CIS types combined. The Australian Institute of Health and Welfare (AIHW) continues to engage with software providers to collaboratively resolve data quality issues in the latest versions of their software products. As a result, 12 JSON files across 7 PHNs that were generated using the latest versions of coding with corrections to these data quality issues were included for reporting (Figure 3); this number is expected to increase over time as practices update their software to the latest versions to correct known data quality issues.

Figure 3: Proportion of PIPQI practices, by data submission pathway and Clinical Information System used, July 2024

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 2023). PHNs vary considerably in geographical size and residential population at a community level (Department of Health 2021), with the number of regular clients increasing with the number of submitting practices (Figure 4), reflecting the underlying estimated regional populations (Figure 5), noting that PHNs tailor services to the complex needs of regional communities and surrounding areas.

Figure 4: PIPQI practices and regular clients aged 15 years and over, by PHN and extraction tool, July 2024

Figure 5: PIPQI QIMs by PHN geographic boundary for July 2024 and Estimated Resident Population as at 30 June 2022