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

The PIP Eligible Data Set

Overview

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 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 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 2020d).

PHNs aim to 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 the general practice patient population, and
• perform needs assessments and plan service delivery at different levels, including local health districts, PHN boundaries, jurisdictional boundaries and nationally.

Clinical information systems

In July 2024, all 31 PHNs completed an AIHW PIPQI data submission survey to provide information on the CISs used by practices participating in the PIPQI Incentive. The most common CISs used were Best Practice (69.1%) and Medical Director (27.3%, including MD Clinical/Insights and Helix combined), with a smaller proportion using other CISs (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%). While most of the PIPQI participating practices used on-premises CIS, at this point in time only 53 practices used MD’s Helix, a cloud-based CIS that cannot be extracted directly and therefore PIPQI data was submitted as a JSON file. Some types of on-premises clinical software, such BP Premier and MD Clinical, have integrated population reporting tools that support user practices (BP Premier Reporting tool and MD Insights, respectively). These reporting tools can also generate PIPQI JSON files for practices that do not use an extraction tool to submit PIPQI data. The proportion of PIPQI practices using each CIS is shown in Figure 1.

Data extraction tools

Between July 2023 and July 2024, there was an increase in the number of PHNs that started using the new Primary Sense extraction tool, from 2 to 12 (6.5% to 38.7%) over this period. There was a corresponding decrease in the number of PHNs using CAT Plus as their sole extraction tool from 23 to 13 (74.2% to 41.9%), whereas the number of PHNs using only the POLAR extraction tool remained unchanged (5, 16.1%). One PHN used a hybrid of CAT Plus and POLAR extraction tools, as in previous years.

In the July 2024 reporting period, there were 2 Primary Sense user PHNs that had not finished moving from the CAT Plus extraction tool and were temporarily using a hybrid data extraction approach. PHNs that used more than one extraction tool during the reporting period provided separate data extracts generated by each tool to the AIHW. To avoid double counting, the data from each practice is only included once in each extract depending on which tool the practice had installed to submit data to their PHN. This approach of supplying hybrid data extracts enables the reporting of PIPQI data disaggregated by extraction tool in the ‘Regional proportions’ section of each QIM.

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. A practice generates an aggregate PIPQI report using either their CIS or an extraction tool (Department of Health 2020a) in accordance with the PIPQI Technical Specification v1.2 (Department of Health 2020b) and submits these data to their PHN using one of the following two submission pathways (Figure 2):

• Submission pathway 1: 5,565 practices (92.9%) used an extraction tool (CAT Plus, POLAR, Primary Sense) to generate and submit a PIPQI report. This approach is referred to as ‘direct extraction’. 
• Submission pathway 2: 423 practices (7.1%) generated a PIPQI report as a JSON (JavaScript Object Notation) file instead, which they submitted to their PHN (Department of Health 2020b). Almost all JSON file supplying practices use their CIS to generate the file, with the exception of a small number of practices that used the CAT Plus or POLAR extraction tools instead – This could be due the practice being more familiar with the extraction tool functions or because their CIS lacked the functionality to generate a PIPQI JSON file.

Data collection

The AIHW obtained Ethics Committee approval on 15 July 2021 for the establishment of this data collection. As of July 2024, 5,563 general practices across 31 PHNs contributed to the national aggregate PIPQI data.

Data from clients who opted-out from sharing de-identified data between practices and PHNs were not extracted and 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 2020c).

Data quality

The AIHW analysed the aggregate data received from PHNs using a series of defined rules to identify and resolve data quality issues. The latest data were compared with the data from the previous quarters and other variance metrics for further analysis. In cases where data did not pass the screening and data quality tests, the respective PHN was asked to review and resubmit the data. 

Clinical software providers regularly release software updates, including QIM coding alignments, to ensure the capture of quality data. However, some practices may be using outdated software versions that output PIPQI data files of poorer quality. To address this, the AIHW collaborated with software and extraction tool providers to align QIM coding in the data outputs generated by their software as well as providing visibility of clinical software versions used to generate JSON files. Having visibility of the software version in JSON files enables PHNs to determine which practices need to apply a software update to produce higher quality data files for public reporting. By keeping practices informed of these software updates, PHNs contribute to the quality of the PIP Eligible dataset. 

The JSON files generated using older versions of coding with known data quality issues are excluded from this report, to ensure that the aggregated PIP Eligible Dataset is of sufficient quality and standard prior to releasing to the National Data Custodian as outlined in the PIPQI Data Governance Framework (Department of Health 2021). In July 2024, 20 PHNs securely provided their directly extracted data files and all JSON files to the AIHW for screening and data quality assessment. The remaining 11 PHNs provided their directly extracted data but were unable to provide all of their JSON files to the AIHW for screening and assessment and the JSON files from these PHNs were excluded for reporting purposes (Figure 2).

To mitigate inconsistencies caused by ongoing data quality issues in the JSON files, PHNs also have been submitting data files to the AIHW which were generated exclusively by direct extraction since January 2023. In this report, the QIM-specific time trend visualisations display only directly extracted data from July 2023 to January 2024. This approach ensures that data of poor quality are excluded, leading to a more accurate representation of the data and trends. Data from April 2024 onwards includes JSON files with good data quality that were generated using updated versions of coding.

The AIHW compiled the data received from PHNs and generated national estimates based on the supplied numerators and denominators for each QIM. The underlying data used for this report are supplied in the Practice Incentives Program Quality Improvement Measures – Data tables for download.

The AIHW observed differences in the aggregate data due to different interpretations of the technical specifications and coding of the QIMs by CIS and extraction tool providers. The resulting differences in the QIM proportions by extraction tool are visualised for each measure in this report.

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 2020e). Therefore, clients who visited a practice 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 in primary care during the COVID-19 pandemic was an essential measure that enabled continuity of care (AIHW 2024a). Temporary telehealth MBS item numbers were made available from 13 March 2020 in response to the COVID-19 pandemic (Department of Health 2022). The use of telehealth has been high since the pandemic started in 2020 compared to the pre-pandemic years, with many of the MBS telehealth items introduced on a temporary basis now made permanent. In 2023, there were over 33 million telehealth attendances, approximately 20% of total number of Medicare-subsidised GP attendances (AIHW 2024h). 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. Readers of this report should take these factors into consideration when interpreting the findings.

From early 2020 to late 2023, an emergency response to COVID-10 was in place in Australia. A range of public health measures were implemented to help contain the spread of the virus that causes COVID-19, including lockdowns, which changed over time and differed across states and territories (AIHW 2024h). Other interventions 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 2022). 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, and service re-orientation to focus on provision of vaccination only (AIHW 2022). A Digital Health Cooperative Research Centre and Macquarie University report from 800 general practices in select Victorian and NSW PHNs 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).

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 attend practices. This may impact some PHN regions more than others due to the high prevalence of holiday homes. Figure 4 presents an estimated count of regular clients aged 15 years and older who visited PIPQI practices during July 2024 in each PHN broken down by the extraction tool used. The estimates are based on the QIM2a denominator.

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

As there are a variety of counting rules to distinguish clinical and non-clinical visits in CISs and extraction tools, figures in this report should be interpreted with these caveats in mind.