QIM 8: Proportion of eligible regular clients with a record of the necessary risk factors in their GP record for CVD risk assessment
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Overview
Assessment of absolute CVD risk based on multiple risk factors is more accurate than that based on individual risk factors due to the cumulative nature of risk effects. Absolute CVD risk assessment combines risk factors to calculate the probability that an individual will develop a cardiovascular event or other vascular disease within a specified time frame, usually 5 years (RACGP 2018). The risk assessment is useful for measuring risk in asymptomatic clients without established CVD (i.e. for primary prevention) (NVDPA 2023) Clients aged 45 – 74 years with established CVD and/or several other conditions who are already clinically determined to be at high risk of a cardiovascular event have been excluded from the measure as outlined in the PIPQI specification (Department of Heath 2020b).
Capture of results recorded outside of the general practice setting
Results arising from clinical intervention conducted outside of the service that are known and recorded by the practice are included in the measure. However, sometimes test results recorded elsewhere may not be captured in this report. For example, this might be a result from a specialist service that is not recorded in the clinical information system (CIS) of the client’s usual general practice due to incompatible CISs between a practice and a specialist service.
Other sources of relevant data
There are other administrative data collections where the relevant data from these client- provider interactions are captured, for example, Medicare Benefits Schedule (MBS) and the National Health Survey (NHS) conducted by the Australian Bureau of Statistics (ABS).
This indicator reports on the proportion of regular clients aged 45 to 74 years without a CVD diagnosis with 4 risk factors (tobacco smoking status, diabetes type or HbA1c result or fasting glucose tests, blood pressure, lipid levels) recorded in their GP record to enable CVD risk assessment.
The QIM proportions summarised by the different extraction tools in use are also shown in the ‘Regional proportions’ bar charts for this measure. This illustrates the differences in how software providers have interpreted the technical specifications and coding of QIMs. QIM8 is one of the more complex PIPQI measures which refers to the recording status of the four necessary risk factors to enable a cardiovascular disease risk assessment. See the Technical notes - Interpreting PIPQI data for a discussion about how applying temporal reference periods to the client’s smoking status can bias the results.
QIM 8: Regional proportions
As of July 2024, nationally, 58.8% of regular clients aged 45 to 74 years without a CVD diagnosis had the necessary risk factors recorded in their GP record to enable CVD risk assessment. This varied from 42.0% to 73.9% across PHNs, and between 46.7% and 62.2% across extraction tools.
Figure 47: Proportion of regular clients aged 45 to 74 years with the necessary risk factors recorded in their GP record to enable CVD risk assessment, by PHN, July 2024
This bar chart shows the proportion of regular clients aged 45 to 74 years with the necessary CVD risk factors recorded in their GP record, by PHN and predominant extraction tool vendors for July 2024.
QIM 8: National proportions over time
Nationally, between July 2023 and July 2024, the proportion of regular clients aged 45 to 74 years without a CVD diagnosis who had the necessary risk factors recorded in their GP record to enable CVD risk assessment increased by 6.2 percentage points from 52.6% to 58.8%.
Figure 48: Proportion of regular clients aged 45 to 74 years with the necessary risk factors recorded in their GP record to enable CVD risk assessment, July 2023 to July 2024
This line chart shows the proportion of regular clients aged 45 to 74 years with the necessary CVD risk factors recorded in their GP record, from July 2023 to July 2024.
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QIM 8: National proportions by age and sex
As of July 2024, the proportion of regular clients aged 45 to 74 years without a CVD diagnosis with the necessary risk factors recorded in their GP record to enable CVD risk assessment increased with age and was:
- highest in the 65–74 years age group for both females (63.8%) and males (64.4%)
- lowest in the 45–54 years age group for both females (53.7%) and males (53.0%).
Figure 49: Proportion of regular clients aged 45 to 74 years with the necessary risk factors recorded in their GP record to enable CVD risk assessment, by age and sex, July 2024
This bar chart shows the proportion of regular clients aged 45 to 74 years with the necessary CVD risk factors recorded in their GP record, by age, sex, and predominant extraction tool vendors for July 2024.
- 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 CISs, 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 (AIHW 2024i).
- The reference periods for recording the risk factors of this QIM have been interpreted and coded differently by extraction tool providers. The POLAR extraction tool used by 6 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), and no reference period for recording smoking status and diabetes screening. In contrast, the CAT Plus extraction tool and Primary Sense extraction tool did not apply any reference period cut-off dates for recording 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.
AIHW (2024i) Aboriginal and Torres Strait Islander specific primary health care: results from the OSR and nKPI collections, AIHW, Canberra, accessed 10 July 2024.
Department of Health (2020b) PIPQI Improvement Measures Technical Specification v1.2 22102020, Department of Health, Canberra, accessed 4 July 2024.
NVDPA (National Vascular Disease Prevention Alliance) (2023) Guidelines for the management of absolute cardiovascular disease risk, accessed 8 July 2024.
RACGP (2018) Guidelines for preventive activities in general practice, 9th edition, updated, RACGP, East Melbourne, Victoria, accessed 8 July 2024.