An accessible and high-quality primary care sector is the backbone of Australia’s health care system. General practitioners (GPs) are the first point of contact for most Australians seeking health care (Department of Health 2020a), with 83.2% of the population seeing a GP in the previous 12 months (AIHW 2020). General practitioners are the most regularly accessed health professionals in Australia, and they are the frontline in the battle against emerging health conditions such as COVID-19 and have taken on significant responsibilities to ensure the safety and wellbeing of all Australians (RACGP 2020).
In 2018-19, nationally there were 158 million GP attendances, or 6.3 per person up from 5.3 per person (113 million) in 2008-09 (claimed through Medicare) (AIHW 2020). Patient age and gender have an effect on the frequency of presentations, with females visiting their GP more than males, and older people visiting their GP more regularly than younger people (RACGP 2020).
The Practice Incentives Program (PIP) Quality Improvement (QI) Incentive is a payment to general practices for activities that 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 ten key Improvement Measures that contribute to local, regional, and national health outcomes (Department of Health 2019b).
Purpose of the report
This is the first annual report on the 10 PIPQI measures. 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. The data, shared at the community level, and collected through the PIPQI Incentive, has the potential to inform primary health providers how to improve care and services to clients and within a population. For example, this report may be used to assist the understanding of 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 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 assess individual general practices or general practitioner performance. There are no set targets for the improvement measures.
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, Primary Health Networks (PHNs) as regional data custodians, and the Australian Institute of Health and Welfare (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 2019a). The Incentive centres on health service events that have taken place against 10 Quality Improvement Measures (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 2020c).
PHNs enhance and connect primary healthcare within their region to achieve better health outcomes. Through their already established trust and working relationship with general practices, PHNs utilise the PIP Eligible Data Set to:
- work in partnership with local general practices to support quality improvement initiatives through reporting and feedback on managing general practice patient population and
- perform needs assessments and plan service delivery at different levels, including PHN boundaries, local health districts, jurisdictional boundaries and at national level.
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. Depending on the method of data submission used in the practices, the report is either generated by the practice’s clinical information systems or by the extraction of data from electronic medical records using a tool (Department of Health 2020c), and in accordance with the PIPQI Technical Specification v1.2 (Department of Health 2020d). Data from clients who have opted-out in sharing de-identified data between practices and PHNs, have not been extracted and therefore are not included in this report. A Review 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 2020b).
Each PHN collates and aggregates PIPQI data extracts from general practices in accordance with the definitions of the 10 QIMs and aggregation and disaggregation permissions of the Data Governance Framework (p15, Table 1, Department of Health 2019a). Aggregate data are then submitted to the AIHW on a quarterly basis, using a secure web-based data submission platform.
Upon receipt of the aggregate data, the AIHW applies a series of pre-defined validation rules to the data to identify any data quality issues. In addition, the data are compared with data from the previous period and other variance metrics. If any validation rules are triggered, the PHN is asked to review their data and either amend it, or confirm that it is correct and provide an optional comment. Inconsistencies and caveats are documented in the Technical notes.
After the regional data are validated, the AIHW compiles the data into a national data collection, and generates national estimates based on the supplied numerators and denominators for each cohort by age and sex for each QIM. The proportions for each QIM are supplied in the Practice Incentives Program Quality Improvement Measures - Data Tables for download.
The AIHW obtained Ethics Committee approval for the establishment of this data collection. As of July 2021, over 5,700 general practices across 31 PHNs contributed to the national aggregate PIPQI data.
PIPQI data submitted by PHNs only includes ‘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, when those service events were eligible for a MBS rebate. This is consistent with the RACGP definition of an active patient/client (RACGP 2010). Therefore, clients who visited a GP 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.
Further, 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 therefore do not represent the total resident population, the total number of individuals who actively attended practices, the prevalence of cohorts or conditions, nor the percentage of total population that attend practices. This may impact some PHN regions more than others due to the high prevalence of holiday homes. Figures in this report should be interpreted with these caveats in mind. Please refer to the Technical notes.
Results included in this report should be interpreted with care, taking into consideration the points raised above. In addition, it should be noted that this report provides information on a specific set of items for PIPQI and does not provide information around the entire care that is provided to a client.
Where data are presented as a time series, the results represent national point-in-time proportions of cohorts with a recorded result at each quarter.
This data should be interpreted in conjunction with other administrative and survey data collections where the data from these client-provider interactions are captured, e.g. Medicare Benefits Schedule (MBS), the Australian Immunisation Register (AIR), the National Diabetes Service Scheme (NDSS) Register, the Australasian Paediatric Endocrine Groups (APEG) state and territory registers, and the National Cancer Screening Register (NCSR), the National Health Survey and State and Territory Health surveys.
For a full list of caveats and footnotes, please refer to the Technical notes.
PHN boundaries and residential population
In 2015, PHNs were established with key objectives of increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care in the right place at the right time (Department of Health 2018). Where possible, boundaries of the PHNs align with Local Hospital Networks (LHNs) or equivalents, or cluster of LHNs to facilitate collaborative working relationships and reduce duplication of effort. The analysis of data at a regional level allows for the planning, commissioning, and provision of health services based upon the local needs assessments of the community.
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 2018).
PHNs vary considerably in geographical size and residential population at a community level (see further PHN Profiles, Department of Health 2015). For example, in the 2016 Census, PHN population by usual residence varied from 63,719 to 1,707,375 persons. Some residents of PHNs may seek health services provided by other adjacent or non-adjacent PHNs. Across PHNs, the percentage of adults (>15 years age) who saw a GP in the previous 12 months in 2018-19 varied from 78% to 86% (AIHW 2020).
For estimated resident populations of PHNs, please refer to the supplementary data table provided in the Practice Incentives Program Quality Improvement Measures - Data tables for download.