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

This page contains general information to aid in interpreting nKPI data. Further information relevant to both collections is provided on the main Technical notes page.

The national Key Performance Indicators (nKPI) collection is a set of process-of-care and health-status indicators organised under 3 domains (Table 1).

Table 1: Indicators by domain and type, December 2022

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.

1. June 2019 was the first collection period in which organisations were advised by the Department of Health that they were not required to provide data for indicators relating to a service they were not funded to provide. Organisations were also advised that if they do not have the data for an indicator (for example because of a CIS issue) to leave it blank.

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 included from organisations with CISs which capture all data necessary to calculate a result (some CISs do not).
• 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.

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 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 CIS

There are variations between 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 CISs 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 in 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.

Key changes to indicators over time include:

• PI01 and PI02 (birthweight): from June 2021, the definition for these indicators was adjusted to capture First Nations babies born in the previous 12 months who had more than one visit (previously included all First Nations babies born in the previous 12 months). From June 2021, multiple births were included in PI02 (previously these were only included in PI01).
• PI03 (health check): from December 2020, the age range captured by this indicator was expanded to include all ages (previously did not include ages 5–24); disaggregation by sex for ages 0–4 was added; and included MBS items were expanded (from only MBS Item 715) to contain:
  • in-person MBS items 715 and 22
  • telehealth MBS items 92004, 92016, 92011 and 92023.
• PI04 (childhood immunisation): this indicator has been retired and was last collected in the June 2020 nKPI collection.
• PI07 (Chronic Disease Management Plan): from December 2020, included MBS items were expanded (from only MBS Item 721) to contain:
  • in-person MBS items 721 and 229
  • telehealth MBS items 92024, 92068, 92055, and 92099.
• PI08 (Team Care Arrangement): this indicator has been retired and was last collected in the June 2020 nKPI collection.
• PI09 and PI10 (smoking): from June 2021, the age range captured by these indicators was expanded to include ages 11–14.
• PI11 (smoking during pregnancy): from June 2021, the definition of this indicator was adjusted to include only the latest smoking status recorded prior to the completion of the latest pregnancy (previously smoking status result was as recorded within the previous 12 months); and the lower age captured was expanded (age groupings changed to ‘less than 20’, ‘20–34’ and ’35 and older’ from ‘15–19’, ‘20–24’, ‘25–34’, and ’35 and older’).
• PI12 Body Mass Index (BMI): from December 2021, the age range captured by this indicator was expanded to include ages 18–24 (previously ages 25 and over); and additional BMI categories were added for ‘underweight (<18.50)’, ‘normal weight (18.50–24.99)’, and ‘not calculated’ (previously overweight and obese only).
• PI13 (first antenatal visit): from June 2021, grouping of gestational age at first visit changed to ‘before 11 weeks’, ‘11–13 weeks’, ‘14–19 weeks’ and ’20 weeks or later’ ‘did not have gestational age recorded’, and ‘did not attend an antenatal care visit’ (previously ‘less than 13 weeks’, ‘13–less than 20 weeks’, ’20 weeks or later’, ‘no result recorded’, and ‘did not attend an antenatal care visit’).
• PI14 (influenza immunisation): from December 2020, the age range captured by this indicator was expanded to ages 6 months and over (previously ages 50 and over only).
• PI15 (influenza immunisation – type 2 diabetes and/or COPD): this indicator has been retired and was last collected in the June 2021 nKPI collection.
• PI17 (AUDIT-C) – this indicator has been retired and was last collected in the June 2022 nKPI collection.
• PI18 (kidney function test type):
  • in December 2021, the age range for this indicator was expanded to be for all ages (previously ages 15 and over), and the test types recorded were revised
  • in June 2022, the age range for this indicator was changed to ages 18 and over.
• PI19 (kidney function test result):
  • in December 2021 this indicator was not collected while modifications were made to its specifications
  • in June 2022, specifications for this indicator were adjusted to add the requirement for both an eGFR and an ACR result to be recorded, add a client group category for ‘type 2 diabetes and/or CVD’, revise the age range to ages 18 and over (previously ages 15 and over), and revise the kidney function test result categories.
• PI22 (cervical screening):
  • From June 2018 to June 2020 – transitional changes were made to align with revised requirements under the National Cervical Screening Program (NCSP). The key changes were to include clients who had either a Papanicolaou smear (Pap test) conducted prior to 1 December 2017 or a human papillomavirus (HPV test) conducted from 1 December 2017; revise the age range to 20–74 to accommodate the former reporting age range (20–69) and the new age range (25–74).
  • From December 2020 – the indicator was revised to collect only HPV tests conducted in the last 5 years where the test occurred on or after 1 December 2017.
• PI24 (blood pressure result): from June 2021, the target blood pressure value was changed to ‘less than or equal to 140/90mmHg’ (previously ‘less than or equal to 130/80 mmHg’).

Maternal and child health organisations

Data from a small number of organisations that received funding only for maternal and child health services (MCH organisations) are included in the nKPI data presented in this report unless otherwise noted.

While MCH organisations are generally excluded from the OSR data presented in this report (see Interpreting OSR data), they are included in the nKPI data. This is because a subset of indicators applies directly to the MCH funded programs and the aims of these programs are considered similar to the aims of antenatal/early childhood care delivered within organisations funded for primary health care.

Prior to June 2019, because MCH organisations were not limited to reporting only on the 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 3 January 2023.