National Key Performance Indicators
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1 National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care First national results June 212 to June 213
2 <Body> National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care First national results June 212 to June 213
3 The Australian Institute Health and Welfare is a major national agency which provides reliable, regular and relevant information and statistics on Australia s health and welfare. The Institute s mission is authoritative information and statistics to promote better health and wellbeing. Australian Institute Health and Welfare 214 This product, excluding the AIHW logo, Commonwealth Coat Arms and any material owned by a third party or protected by a trademark, has been released under a Creative Commons BY 3. (CC BY 3.) licence. Excluded material owned by third parties may include, for example, design and layout, images obtained under licence from third parties and signatures. We have made all reasonable efforts to identify and label material owned by third parties. You may distribute, remix and build upon this work. However, you must attribute the AIHW as the copyright holder the work in compliance with our attribution policy available at < The full terms and conditions this licence are available at < Enquiries relating to copyright should be addressed to the Head the Communications, Media and Marketing Unit, Australian Institute Health and Welfare, GPO Box 57, Canberra ACT 261. This publication is part the Australian Institute Health and Welfare s National key performance indicators for Aboriginal and Torres Strait Islander primary health care series. A complete list the Institute s publications is available from the Institute s website < ISSN ISBN Suggested citation Australian Institute Health and Welfare 214. National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213. National key performance indicators for Aboriginal and Torres Strait Islander primary health care series. IHW 123. Canberra: AIHW. Australian Institute Health and Welfare Board Chair Dr Andrew Refshauge Director David Kalisch Any enquiries about or comments on this publication should be directed to: Media and Strategic Engagement Unit Australian Institute Health and Welfare GPO Box 57 Canberra ACT 261 Tel: (2) info@aihw.gov.au Published by the Australian Institute Health and Welfare Please note that there is the potential for minor revisions data in this report. Please check the online version at < for any amendments.
4 Contents Acknowledgments.. v Abbreviations. vi Symbols.. vii Summary viii Key findings.. viii Implications... ix Chapter 1: Introduction.. 1 nkpi data. 2 Clients. 2 Organisations contributing nkpi data 2 Chapter 2: Organisation performance against individual indicators.. 6 General data issues. 7 Things to consider when interpreting the data 8 A. First antenatal visit... 1 B. Birthweight recorded by the organisation. 12 C. Birthweight result 14 D. MBS health assessment (item 715) for children aged E. MBS health assessment (item 715) for adults aged F. Cervical screening 2 G. Immunised against influenza clients aged 5 and over. 22 H. Immunised against influenza clients with type 2 diabetes 24 I. Immunised against influenza clients with chronic obstructive pulmonary disease. 26 J. General Practitioner Management Plans clients with type 2 diabetes.. 28 K. Team Care Arrangements clients with type 2 diabetes.. 3 L. HbA1c result recorded clients with type 2 diabetes M. HbA1c result clients with type 2 diabetes N. Kidney function test clients with type 2 diabetes.. 36 O. Kidney function test clients with cardiovascular disease P. Blood pressure recorded clients with type 2 diabetes 4 Q. Blood pressure result clients with type 2 diabetes. 42 R. Smoking status recorded 44 S. Smoking status result.. 46 T. Alcohol consumption status recorded U. Overweight and obese 5 V. Child immunisation. 52 National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213 iii
5 Chapter 3: Factors that made a difference 54 Introduction.. 55 Importance CQI three lines evidence.. 56 Differences between jurisdictions and by remoteness 57 Staffing.. 58 Other factors. 6 Factors associated with inconsistent conclusions 6 Chapter 4: Individual organisation performance against process care indicators. 62 Overall performance. 62 Chapter 5: Conclusion Appendix 1: List nkpis as at June Appendix 2: Summary indicators 71 Appendix 3: Data quality. 74 Appendix 4: Guide to the figures 78 Appendix 5: Performance by organisation size 81 Appendix 6: Organisations in both nkpi and OSR collections 83 Appendix 7: Regression analyses factors influencing recording/outcomes 84 Appendix 8: Logistic regression model. 92 Appendix 9: Measures included in each chapter.. 95 Glossary.. 96 References.. 98 List tables. 1 List figures 11 List boxes.. 15 iv National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213
6 Acknowledgments Devin Bowles, Sonam Shelly and Michelle Harvey the Indigenous Community and Health Service Reporting Unit at the Australian Institute Health and Welfare prepared this report with assistance from other unit staff, including Kathryn Sedgwick, Alex Topfer, Denise Arnold, Kate Bradbury, Xiang Wang, Richard Tuttle, Corinna Schultz, Amie Zhang and Amitha Jason. Indrani Pieris-Caldwell heads the unit, and provided guidance and comments throughout the process. Rebecca Rodgers, who assisted with the final proread the report, is also acknowledged. We are grateful to David Whitelaw for his independent statistical advice. Fadwa Al-Yaman is acknowledged for her comments and guidance throughout the project. The Australian Government Department Health funds the national Key Performance Indicator (nkpi) project. Members the Indigenous and Rural Health Division provided substantial guidance and comments on this report. The Department Health provided all text dealing with policy implications the data, including the Opportunities for action sections the report, Chapter 5 Conclusion and the Implications section the Summary. We would like to thank all primary health-care that provided the data contained within this report. The contribution each organisation is greatly appreciated and gratefully acknowledged. National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213 v
7 Abbreviations AATSIHS Australian Aboriginal and Torres Strait Islander Health Survey ABS ACIR ACR ACT AHW AIHW BMI COPD CQI CVD FTE egfr GP GPMP HbA1c MBS METeOR mmhg Australian Bureau Statistics Australian Childhood Immunisation Register albumin/creatinine ratio Australian Capital Territory Aboriginal Health Worker Australian Institute Health and Welfare body mass index chronic obstructive pulmonary disease continuous quality improvement cardiovascular disease full-time equivalent estimated glomerular filtration rate general practitioner General Practitioner Management Plan glycosylated haemoglobin Medicare Benefits Schedule Metadata Online Registry millimetres mercury NATSIHS National Aboriginal and Torres Strait Islander Health Survey nkpi NPDC NSW NT OSR Qld SA T2D Tas TCA Vic WA National Key Performance Indicator National Perinatal Data Collection New South Wales Northern Territory Online Service Reporting Queensland South Australia type 2 diabetes Tasmania Team Care Arrangement Victoria Western Australia vi National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213
8 Symbols nil or rounded to zero or no trend data.. not applicable n.a. not available no change increased decreased < less than less than or equal to > greater than greater than or equal to National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213 vii
9 Summary This is the first national report on the Indigenous primary health-care national Key Performance Indicators (nkpis) data collection. It covers all the indicators collected since June 212, and presents data analysed at the national level by jurisdiction, remoteness, and organisational size. The data are collected from over 2 primary health-care receiving funding from the Australian Government Department Health to provide services primarily to Aboriginal and Torres Strait Islander people. The purpose the nkpis is to improve the delivery primary health-care services by supporting continuous quality improvement (CQI) activity among service providers. The nkpis also support policy and planning at the national and state/territory level by monitoring progress and highlighting areas for improvement. The 19 indicators presented in this report focus on chronic disease prevention and management and on maternal and child health. These are two key areas for achieving the objective closing the gap in life expectancy between Aboriginal and Torres Strait Islander Australians and non-indigenous Australians. The nkpis provide information on both process care indicators and health outcomes for clients. The former are largely under the control and indicate good practice in primary health care. Health outcomes are influenced by the work primary health care; however, they are also influenced by socioeconomic factors such as education, employment, income and housing, which are beyond the immediate control primary health-care. A progress summary the 19 nkpis is shown at Table S1. Key findings For the three reporting periods covered by this report (those ending in June 212, December 212 and June 213), improvements were seen for most the process care indicators. The national proportions increased by 5 9 percentage points for the following five indicators: proportion babies with birthweight recorded Medical Benefits Schedule health assessments for adults clients with type 2 diabetes who received a Team Care Arrangement recording smoking status recording alcohol use status. The analyses data by jurisdiction indicated that in Queensland and the Northern Territory performed better against almost all process care indicators. This may be due to these jurisdictions having well-established CQI programs that encouraged the development and reporting against KPIs for several years before the start the nkpis. Organisations with a small number clients per general practitioner performed better against a large number indicator measures. Smaller (those with a small number clients) did better than those with more clients on several indicators, including clients aged 5 and over immunised against influenza and HbA1c results recorded. viii National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213
10 Implications These early results have important implications: They show that improvements have occurred across most process care indicators. These improvements should result in better health outcomes for Aboriginal and Torres Strait Islander people. Of particular note is the finding that the with better performance are spread across diverse geographic and service delivery environments. Small can and ten do perform well, as do larger. The analysis also shows that well-established CQI programs make a positive difference and supports the view that the nkpi system itself can contribute to local CQI endeavours. While the process creating sound and evidence-based benchmarks is in its early stages, it is possible to use the nkpi data to identify areas where improvements are feasible. The need for good quality data is paramount to this. There is a wide range in performance across all indicators. Service providers can compare their results with the detailed analysis on each indicator in this report as a way informing their CQI activities. For some, prompt action is indicated to identify the reasons for poor results and to develop strategies to improve the quality services they provide. The report shows a number key issues that require further investigation and/or development to inform the continuing improvement the nkpi system itself. These include the possible development benchmarks, and investigation the robustness current data gathering and recording processes in areas such as immunisation and kidney function tests. The report also highlights the need for further development a CQI system that supports in improving the delivery primary health-care services for Aboriginal and Torres Strait Islander people. Table S1: Progress nkpis over time, June 212 to June 213 Indicator Change over time Indicator Change over time PI 1: Birthweight recorded PI 9: Smoking status recorded PI 2: Birthweight result PI 1: Smoking status result PI 3: MBS health assessments 4 years 25 years and over PI 12: BMI result (overweight or obese) PI 13: First antenatal visit PI 4: Child immunisation PI 5: HbA1c test recorded 6 months 12 months PI 14: Clients aged 5+ immunised against influenza PI 15: Clients with type 2 diabetes/ COPD immunised against influenza PI 16: Alcohol consumption recorded PI 6: HbA1c result 7% 6 months 7% 12 months PI 19: Type 2 diabetes/cvd clients with kidney function test recorded PI 22: Cervical screening PI 7: MBS GPMP PI 23: Clients with type 2 diabetes with blood pressure test recorded PI 8: MBS TCA PI 24: Clients with type 2 diabetes with blood pressure 13/8mmHg National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213 ix
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12 Chapter 1 Introduction This is the first report on the Indigenous primary health-care national Key Performance Indicators (nkpis) data collection. The data in this report are collected from 26 primary health-care (Aboriginal Community Controlled as well as those with other governance arrangements) that receive funding from the Australian Government Department Health to provide services primarily to Aboriginal and Torres Strait Islander people. These data are collected and reported to health to help improve the delivery primary health care for Aboriginal and Torres Strait Islander people, to improve health outcomes and to support progress towards the Council Australian Governments Closing the Gap targets. The 19 indicators in this report focus on chronic disease prevention and management and on maternal and child health. (Additional indicators are to be added progressively in the future.) These are the two key focus areas to achieve the objective closing the gap in life expectancy between Indigenous and non-indigenous Australians. A list indicators and more information on their development can be found at Appendix 1. There is sound evidence to support the contribution that performance indicator systems can play in the delivery effective primary health care when they are integrated with sound continuous quality improvement (CQI) strategies (Bailie et al. 27). The nkpis build on a body work in Australia that integrates primary care performance data with quality improvement methods. This work includes the Australian Primary Care Collaboratives, the Audit and Best Practice for Chronic Disease program, the Northern Territory Aboriginal Health Key Performance Indicators project, the Queensland Aboriginal and Islander Health Council Health Information System, and the Healthy for Life program. CQI is one component a broader health system response that is required to improve primary health-care delivery. On their own, the nkpi data will not lead to positive change, improvements in service delivery or to improved outcomes. However, when used by health service providers at the local level to identify opportunities and to measure progress towards achieving change, they can make an important contribution. For some, getting the most value out the nkpis will require substantial change to the systems and processes in place to collect high-quality data. The process making sense the data and adopting CQI practices requires organisational commitment, capability and capacity. A potentially important factor influencing organisation performance on the nkpis is the level funding each organisation receives relative to the size the population it serves, the level need in the population, and the geographic context in which the organisation works. This report does not analyse performance in relation to resources. It works on the assumption that there is room for improvement regardless the level resourcing, while acknowledging that the level resourcing may constrain how much improvement is possible. This report is designed to highlight the major areas achievement primary health-care providers as well as the areas where improvements are needed by in the delivery services to their clients. These findings need to be understood in the context the constraints within which operate and the possibility that some results relate to data collection issues rather than to service delivery issues. This report also needs to be seen as the start reporting against the nkpis. It signals many areas where the underlying data collection systems need to be further refined and developed as well as enhancements to the processes analysis, reporting and communication. A commitment to quality improvement is something that needs to be shared across all parts a national approach to the provision primary health care for Aboriginal and Torres Strait Islander people. National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213 1
13 nkpi data As with any data collection, there are some limitations in the nkpi data that should be taken into account when interpreting the information provided in this report. These limitations include the fact that data are captured as part service delivery processes, and the double counting clients who attend more than one service regularly. Additionally, the Australian Institute Health and Welfare (AIHW) noted internal inconsistencies for some data for some. These data were excluded from the national analysis. A detailed description the data collection processes and issues associated with the data, including issues related to the regular client definition, is presented in Chapter 2. Clients The population interest in the nkpis is the regular client population those primary health-care that are required to report against the nkpis. A regular client is defined as a person who has an active medical record that is, a client who attended the primary health-care organisation at least 3 times in the last 2 years. This definition, while nationally consistent and in line with the Royal Australian College General Practitioners definition a patient with an active medical record, has limitations, including clients who attend multiple health. Organisations contributing nkpi data The nkpi data have been collected for 3 reporting periods, after an initial trial involving about 8 with previous data collection experience. The number participating increased from 9 in June 212 to 26 in June 213. Organisations reporting include Aboriginal Community Controlled Health Organisations, that are not community controlled, state/territory and local government, non-government, auspiced and Medicare Locals. Organisations may report nkpi data through OCHREStreams. The overall distribution reporting nkpi data shows that they are located across all jurisdictions and remoteness areas. Figure 1.1: Map organisation location: jurisdiction and remoteness 2 National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213
14 Figure 1.1: Map organisation location: jurisdiction and remoteness The number The disaggregated number by jurisdiction disaggregated and by remoteness jurisdiction and area remoteness show that area more show that more are located are located in in NSW/ACT NSW/ACT than in than other in jurisdictions, other followed jurisdictions, by the NT. followed by the NT. Most Most NT NT are located are located in Very remote areas while most NSW/ACT in Very remote areas while most are in Major cities and Inner NSW/ACT are in regional areas. Major cities and Inner regional areas. Jurisdiction NT 1 12 SA WA Qld Major cities Inner regional Outer regional Remote Very remote Vic/Tas NSW/ACT Number NSW/ACT, Queensland and the NT have more Indigenous NSW/ACT, regular Queensland clients than and other NT jurisdictions. have more Indigenous regular the NT Indigenous population. clients than other jurisdictions. Total the NT Indigenous regular population. clients Total seen Indigenous represent regular 4% clients Indigenous seen represent people 4% nationally. Indigenous Clients people seen at nationally. NT Clients seen represent at NT 88% represent 88% the NT Indigenous population. Note: Organisations in the Australian Capital Territory and Tasmania have been combined with those in New South Wales and Victoria, respectively, due Note: to small Organisations numbers. in the Australian Capital Territory and Tasmania have been combined with those in New South Wales and Victoria, respectively, due to small numbers. Figure 1.2: Number by jurisdiction and remoteness, June 213 Figure 1.2: Number by jurisdiction and remoteness, June 213 Clients 7, Clients 6, 7, 5, 6, 4, 5, 3, 4, 2, 3, 1, 2, 1, <Publication title [footer double-click to insert]> 3 The number Indigenous regular The clients The number number in Indigenous Indigenous regular increased regular clients in consistently clients in increased with increasing consistently increased with increasing remoteness, consistently remoteness, with increasing Very with Very remote remote areas areas having remoteness, having the the largest with Very number remote areas clients. Clients having Clients who the who were largest were seen at seen number Very at remote Very clients. remote represented represented about 69% the Clients who were seen at Very total Indigenous population in Very remote about remote 69% the total represented Indigenous areas; however, this may reflect some the population in Very remote areas; double about counting 69% the clients total in Indigenous Very remote locations. population however, this in may Very reflect remote some areas; the however, double this counting may reflect clients some in the Very double remote counting locations. clients in Very remote locations. The nkpi regular client population by The jurisdiction nkpi regular and client remoteness population area is by not jurisdiction necessarily and in remoteness line with the area estimated is not necessarily resident in Indigenous line with the population estimated resident distribution Indigenous in these Figure 1.3: Clients by jurisdiction, June 213 Figure 1.3: Clients by jurisdiction, June 213 Figure 1.3: Clients by jurisdiction, June 213 Clients 7, Clients 7, 6, 6, 5, 5, 4, 4, 3, 3, 2, 2, 1, 1, Major cities Inner Outer Remote Very (28) regional regional (26) remote (61) Major cities Inner (46) Outer (45) Remote Very (28) regional regional (26) remote (61) (46) (45) Figure 1.4: Clients by remoteness, June 213 Figure 1.4: Clients by remoteness, June 213 Figure 1.4: Clients by remoteness, June 213 nkpi Major Cities National Key Performance Indicators for Aboriginal and Torres Strait ERP Islander primary health care: first national results June 212 to June 213 nkpi Inner nkpi Major Regional Cities ERP ERP Outer Inner Regional nkpi Remote nkpi Outer Regional A WA NT NT 3
15 the double counting clients in Very remote locations. (28) regional (46) regional (45) Figure 1.4: Clients by remoteness, June 213 (26) remote (61) The The nkpi nkpi regular regular client client population population by jurisdiction by jurisdiction and remoteness and remoteness area is not area necessarily is not necessarily in line with in the line estimated with the resident estimated Indigenous resident population Indigenous distribution in these areas. This should be noted when population distribution in these comparing data across jurisdictions and remoteness. areas. This should be noted when comparing data across jurisdictions It should also be noted that Indigenous and remoteness. people living in Major cities and some regional It should areas also may be have noted access that to more health Indigenous service options people than living in Remote in Major and cities Very and Remote some areas. regional More generally, areas may the have number access nkpi to more health health service available options may than vary in in Remote each jurisdiction and Very or remoteness area in relation to the Remote areas. More generally, the population in these areas. number nkpi health available may vary in each jurisdiction or remoteness area in relation to the population in these areas. Vic Tas Qld SA WA NT NSW ACT nkpi ERP nkpi ERP nkpi ERP nkpi ERP nkpi ERP nkpi ERP Major Cities Inner Regional Outer Regional Remote Very Remote 5, 1, 15, 2, 25, Notes 1. Outer regional, Remote and Very remote areas Victoria and Tasmania Notes: have been combined due to small numbers and reported in the category Outer regional ERP is Outer the Estimated regional, Resident Remote Population. and Very remote areas Victoria and Tasmania have been combined due to small numbers and reported in the category Outer regional. Figure 1.5: Indigenous population in the nkpi collection 2. ERP is the and Estimated the general Resident Indigenous Population. population (ERP) as at 3 June 211 Figure 1.5: Indigenous population in the nkpi collection and the general Indigenous population 4 <Publication title [footer double-click to insert]> 4 National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213
16 Structure the report The remaining chapters are organised as follows: Chapter 2 presents data for each indicator at the national and jurisdictional level and by remoteness. It shows areas where performance is strongest. It also shows areas that need further improvements by ranking an organisation s performance into quartiles and describing those in the first and fourth quartiles. A summary the nkpi results as well as national comparison data are presented at Appendix 2, while Appendix 3 expands the discussion on data quality. A guide to the figures presented in this chapter is provided at Appendix 4. Appendix 5 includes analysis overall performance against the nkpis by organisation size. Unless otherwise noted, all graphs are for the period ending 3 June 213. Chapter 3 uses regression modelling to look at the factors that had an impact on organisational performance, and the outcomes for clients. This analysis provides insights into some potential focus areas for improving organisational performance. This chapter used data from the Online Service Reporting (OSR) collection; therefore, information on that participated in both nkpi and OSR collections are presented at Appendix 6. Chapter 4 presents organisational performance against individual process care indicators. It shows the extent to which are able to report on each these indicators. A conclusion is provided at Chapter 5. This report also has a number appendixes. A list nkpis is shown at Appendix 1. Appendix 2 summarises the nkpis with comparisons made, where possible, with national data for Aboriginal and Torres Strait Islander people. Specifically, comparisons are made with the recent Australian Bureau Statistics (ABS) Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS) for the smoking status and body mass index (BMI) indicators. Comparisons are also made with the National Perinatal Data Collection (NPDC) for birthweight result. A detailed discussion data quality issues that should be considered when interpreting the data can be found at Appendix 3. Appendix 4 provides a guide to the figures discussed in this chapter. Appendix 5 analyses performance by organisation size. Appendix 6 looks at the characteristics in both the nkpi and OSR data collections. Appendix 7 shows detailed results the logistic regression analysis. Appendix 8 provides an in-depth discussion the logistic regression model. Appendix 9 lists which measures were discussed in each chapter. National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213 5
17 Chapter 2 Organisation performance against individual indicators This chapter presents the organisational performance against individual process care indicators, as well as the outcomes for clients against a number outcome indicators. Information is presented at the national level, jurisdictional level and by remoteness region. Further disaggregations such as remoteness by jurisdiction are not undertaken in this report to avoid potential identification data specific to individual. Interquartile ranges as well as the median value for are presented to show the variation across. Indicators in this chapter are organised into the following groups: Child and maternal health Health assessments and early detection Immunisation Chronic disease Risk factors. Four the 19 indicators in this report look at two or more distinct population groups. These indicators are: Medical Benefits Schedule (MBS) health assessment for children aged 4 and for adults aged 25 and over. Regular clients with type 2 diabetes and regular clients with chronic obstructive pulmonary disease (COPD) immunised against influenza. Regular clients with either type 2 diabetes or cardiovascular disease (CVD) who have had a kidney function test. Regular clients who were fully immunised at ages 1, 2 and 5. In order to distinguish between the high-level indicator and its associated population groups, this report refers to them as indicator measures. As a result, there are 24 measures for the 19 indicators presented in this report. The child immunisation indicator examines three age groups; however, due to data quality issues, this indicator and its sub-components have been excluded from most analyses in this report. Due to exclusion the child immunisation data, only 21 indicator measures are discussed at most places in this report. Of these, 16 are process care measures and 5 are outcome measures. Process care measures vary in terms the complexity the process care that they measure. Some require action by a single health worker; others require action from multiple workers or even multiple. Indicators any type are designed to measure something beyond themselves. For instance, recording blood pressure and HbA1c results for clients with type 2 diabetes provides a good, though imperfect, measure overall care for these clients. These indicators are also important in and themselves as activities that impact on health outcomes, or health outcomes that are important to morbidity and mortality. Additional information to assist with the analyses presented can be found in Appendixes 1 5. This chapter discusses the top and bottom 25%. This description refers to the quartiles performance against each indicator. The first quartile (bottom quartile or below the 25th percentile) shows the 25% that had the lowest values for the indicator; the top quartile (above the 75th percentile) separates the 25% that had the highest values for an indicator from the rest. Circumstances unique to a particular organisation may contribute to how well it performs relative to other. 6 National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213
18 General data issues There are a number data issues relevant to most nkpis that should be considered when interpreting the results (for more details, see Appendix 3): The number that provided valid data is different for different measures. The number reporting nkpi data increased over time. New were added in different reporting periods, which can affect results. For instance, the proportion babies whose birthweight was recorded decreased in South Australia in December 212 compared with June 212. This decrease was primarily because a number new were introduced, which, on average, had a lower proportion babies whose birthweight was recorded. Additionally, 26 Northern Territory Government reported for the first time for the reporting period ending June 213. Changes in the Northern Territory average, and to a lesser extent changes in the Very remote and national averages, should be interpreted with this in mind. There is some likely double counting the same client at multiple, especially at those in Very remote areas. However, the extent this nationally is unknown and difficult to quantify. Organisations from different sectors provided data. For instance, many the were Aboriginal Community Controlled Health Organisations, but many had different governance arrangements. Organisations used various Patient Information Recall Systems. These may facilitate recording information related to some indicators more than others. Additionally, some were less compatible with other components the electronic data transfer system used by to report data. In addition to these considerations, many the indicators discussed in this chapter should be interpreted in light additional information that applies to some measures only, noted in the Things to consider when interpreting the data box below. National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213 7
19 Box 1: Things to consider when interpreting the data The nkpis, like performance indicator systems generally, are useful but imperfect measures system characteristics that are agreed to be important. In order to maximise their usefulness, data users need to understand where and how the nkpi data might depart from the reality that the indicators are attempting to measure. These notes are designed to help nkpi data users appreciate and work constructively with the data that appear in this report and in service-level reports. Babies records: The two indicators related to birthweight include any baby with a record at the health organisation. This may mean that some babies whose parents are regular clients are not included in these indicators. It may also lead to babies being included who visited the organisation purely for acute care, and whose carers may not have been able to confirm birthweight. Babies without a medical record, whose information is recorded in their mother s record, would not be counted. Multiple births should not count toward birthweight results; however, anecdotal evidence suggests that such exclusion may not always have occurred. Differential BMI testing may occur in some. That is, BMI may be more likely to be measured in clients who look underweight, overweight or obese. This would result in the apparent proportion overweight or obese clients being higher than it actually is. However, the fact that there is a lower proportion overweight and obese regular clients than in the AATSIHS data suggests this effect is unlikely to be very important. Influenza vaccination does not record clients who are fered a vaccination but refuse. While some clients may be reluctant to have the injection, this does not change whether or not they are at increased risk from influenza. Opposite trends for recording and results: In two sets related indicators HbA1c tests and blood pressure tests the proportion clients who had information recorded declined over time, while the proportion that had a positive result increased over time. Beyond normal fluctuation, the most likely explanation for this is an increase in the number regular clients with type 2 diabetes. Data from Healthy for Life show an upward trend in the number clients with type 2 diabetes (AIHW 213), which could reflect increased incidence, more complete diagnosis, and better outreach to unhealthy people in the community. New clients and newly diagnosed clients may be less likely to have their HbA1c or blood pressure under control. MBS items are not claimed by all, either because they do not have a general practitioner (GP) present, they are not eligible to claim them or because they choose not to do so. Therefore, the indicators based on MBS items may not reflect all related health-care activities carried out in an organisation. For instance, children may be receiving comprehensive health checks but these may be provided within a model care that does not suit or allow for the check to be claimed as an MBS item. Pathology results held at the organisation may not reflect all pathology tests that have occurred for its regular clients. Organisations without systems in place may not have recorded the information, or results may not have been picked up accurately. Access to allied health providers may be limited in some areas, in which case Team Care Arrangements (TCAs) may not be practical. This is ten the case in remote regions. Recording alcohol consumption is not restricted to a particular test or format for this indicator. Organisations can use tests such as the AUDIT or AUDIT-C, or simply record whether or not the client consumes alcohol. Shared care arrangements between hospitals and primary health, or between primary care, or between primary health care and other providers similar care are not consistently supported by automatic data sharing. This could lead to lower rates data recording for some indicators. For instance, may find it more difficult to obtain antenatal records if antenatal care occurred elsewhere. Similarly, it will be difficult for to obtain information on their regulr clients who may choose to receive cervical screening elsewhere. Continued 8 National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213
20 Small organisation denominators: All relevant were included in the analyses, without any differentiation for organisation size. This means that the set organisation percentages used to compute quartiles (for example) are based on client sets that can range from very small to very large (Appendix Figure A5.1). Where an organisation has a small denominator, small changes in the numerator can have a large impact on the overall proportion for that organisation. This is true for all the indicator measures in this chapter. The proportion with a denominator less than 2 clients exceeded 1% all contributing for 14 the 21 measures. These measures have been flagged with a note. One measure, clients with COPD immunised against influenza, had 87% with a denominator less than 2. This was substantially higher than all other measures. Smoking status categories are not yet fully agreed. For example, there is not yet universally accepted guidance on how long a person needs to have quit smoking to be considered an ex-smoker rather than a smoker. An increased number types ex-smokers might enhance data quality and lead to more frequent updating clients records. Time-stamped records normally ensure that a record or activity is fairly recent. However, the smoking status recorded and smoking status result indicators are based on the most recent record for the client, regardless how old that record is. Therefore, the indicator may not reflect current smoking status the regular client population unless the data have been collected recently for all or most clients. National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213 9
21 A. First antenatal visit A. Headline First antenatal results visit Headline results Nationally, Nationally, 35% 35% Aboriginal Aboriginal and and Torres Torres Strait Strait Islander Islander regular regular clients clients had had their their first first Headline antenatal results antenatal visit visit before before weeks weeks pregnancy pregnancy as as at at June June (Figure (Figure 2.A1). 2.A1). Nationally, Trend Trend data data 35% are are Aboriginal not not available. available. and Torres Organisations Organisations Strait Islander located located regular in in clients Remote Remote had areas areas their had first had antenatal the the highest highest visit before 13 proportion weeks pregnancy as at June 213 (Figure 2.A1). proportion antenatal antenatal visits visits before before weeks weeks pregnancy pregnancy as as well well as as the the highest highest proportion proportion with Trend with no data no data are data recorded not recorded (Figure available. (Figure 2.A2). Organisations 2.A2). located in Remote areas had the highest proportion antenatal visits Organisation Organisation before 13 weeks performance performance pregnancy (Figure (Figure as well 2.A3): as 2.A3): the highest proportion with no data recorded (Figure 2.A2). Organisation Five Five (5) (5) performance (Figure had had 1% 2.A3): 1% clients clients attending attending their their first first antenatal antenatal visit visit before before 13 Five 13 weeks (5) weeks pregnancy. pregnancy. had 1% clients attending their first antenatal visit before 13 weeks pregnancy. Twenty-six Twenty-six Twenty-six (26) (26) (26) had had no pregnant had no no pregnant women pregnant women attending women attending before attending before 13 weeks before 13 pregnancy. 13 weeks weeks pregnancy. pregnancy. In the top 25%, at least 47% women had their first antenatal visit before 13 weeks pregnancy. In In the the top top 25% 25%,, at at least least 47% 47% women women had had their their first first antenatal antenatal visit visit before before 13 weeks pregnancy. In the 13 bottom weeks 25% pregnancy., fewer than 16% women had their first antenatal visit before 13 weeks pregnancy. In In the the bottom bottom 25% 25%,, fewer fewer than than 16% 16% women women had had their their first first antenatal antenatal visit visit before before weeks weeks pregnancy. pregnancy. Variation Variation in the in timing the timing first antenatal first antenatal visit by age visit at by pregnancy: age at pregnancy: Women aged Women 2 34 were aged more 2 34 likely were than those Variation in other age in the groups timing to attend first antenatal antenatal care visit before by 13 age weeks at pregnancy: pregnancy. Women A high proportion aged 2 34 (36%) were more likely than those in other age groups to attend antenatal care before 13 weeks women more aged likely less than those 2 had in their other first age antenatal groups visit to later attend than antenatal 2 weeks care pregnancy before 13 (Figure weeks 2.A4). pregnancy. pregnancy. A high high proportion proportion (36%) (36%) women women aged aged less less than than 2 2 had had their their first first antenatal antenatal Organisation visit visit later later than than size did 2 2 weeks not weeks greatly pregnancy pregnancy affect the proportion (Figure (Figure 2.A4). 2.A4). women attending their first antenatal visit before 13 weeks pregnancy. A few small had 1% women having their first antenatal visit before Organisation size did not greatly affect the proportion women attending their first 13 Organisation weeks (Appendix size Figure did A5.1). not greatly affect the proportion women attending their first antenatal antenatal visit visit before before weeks weeks pregnancy. pregnancy. A few few small small had had 1% 1% women women having having their their first first antenatal antenatal visit visit before before weeks weeks (Appendix (Appendix Figure Figure A5.1). A5.1). Less than 13 weeks 13 to 2 weeks Greater Less than than 13 2 weeks weeks Not 13 to recorded 2 weeks Greater than 2 weeks Not recorded NSW & Vic & Qld WA SA NT National NSW ACT & Tas Vic & Qld WA SA NT National ACT Tas Figure Figure 2.A1: 2.A1: Timing Timing first first antenatal antenatal visit, visit, by by jurisdiction Figure 2.A1: Timing first antenatal visit, by jurisdiction jurisdiction Less than 13 weeks 13 to 2 weeks Greater Less than than 13 2 weeks weeks Not 13 to recorded 2 weeks Greater than 2 weeks Not recorded Major Inner Outer Remote Very Major Inner Outer Remote Very cities regional regional remote cities regional regional remote Figure Figure 2.A2: 2.A2: Timing Timing first first antenatal antenatal visit, visit, by by remoteness remoteness Figure 2.A2: Timing first antenatal visit, by remoteness Number Figure 2.A3: Distribution percentage clients whose first antenatal visit was before Figure 2.A3: Distribution percentage clients whose first antenatal visit was before 13 weeks 1 <Publication title [footer double-click to insert]> pregnancy, 113 weeks <Publication pregnancy, by organisation by organisation title [footer double-click to insert]> Why is this important? Distribution Upper quartile boundary (46.9%) Median organisation (3.8%) Lower quartile boundary (15.6%) National per cent clients (34.7%) <1 1 <2 2 <3 3 <4 4 <5 5 <6 6 <7 7 <8 8 < National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213 An early antenatal visit can reduce the risk health complications for the mother and the baby as substantial health impacts can occur in the first trimester during critical periods 6
22 Figure 2.A3: Distribution percentage clients whose first antenatal visit was before 13 weeks pregnancy, by organisation Why is this important? Why is this important? An early antenatal visit can reduce the risk health complications for the mother and the An early baby antenatal as substantial visit can reduce health the impacts risk health can complications occur in the for first the trimester mother and during the baby critical as periods substantial brain health development. impacts can occur in the first trimester during critical periods brain development. Collecting data on the timing first antenatal visits can inform knowledge clinical practice and Collecting data on the timing first antenatal visits can inform knowledge clinical patient behaviour. practice and patient behaviour Less than 13 weeks 13 to 2 weeks Greater than 2 weeks Not recorded Under and over Age (years) Figure 2.A4: Timing first antenatal visit, by age Figure 2.A4: Timing first antenatal visit, by age Opportunities for action June 213 was the first time data were collected on this indicator. Improvement on this indicator is possible, though the degree organisational influence is affected by women s health literacy and other factors, including access to staff qualified to provide antenatal care. Completeness recording antenatal visits is important nationally, 1% clients first antenatal visit was not recorded. All could work towards achieving 47% women having their first antenatal visit within 13 weeks pregnancy. One-quarter all currently achieve this. NPDC data showed that, in 211, 45.9% Aboriginal and Torres Strait Islander women attended their first antenatal visit within 13 weeks pregnancy (AIHW NPDC unpublished). This is a reasonable starting point to consider as a benchmark that could initially work towards. More research is required into the barriers women face in accessing antenatal care. Things to consider Babies records Shared care arrangements Small organisation denominators. <Publication title [footer double-click to insert]> 11 National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June
23 <Publication title [footer double-click to insert]> 13 B. B. B. B. Birthweight recorded by the by organisation the organisation Headline results Nationally, 58% Aboriginal and Torres Strait Islander babies born in the previous year had their birthweight Nationally, Nationally, 58% 58% 58% Aboriginal Aboriginal and and Torres Torres Strait Strait Islander babies born in in the the previous year recorded at the primary health-care organisation as at June 213 (Figure 2.B1). had had their had their birthweight birthweight recorded recorded at at the at the the primary primary health-care organisation as as at at June June Trend showed an increase about 7 percentage points between June 212 and June 213 (Figure 2.B1). (Figure (Figure 2.B1). 2.B1). There were improvements in most jurisdictions and remoteness areas (figures 2.B1 and 2.B2). Trend showed an an increase about 7 7 percentage points between June 212 and and June 213 Trend Organisation showed performance increase (Figure about 2.B3): 7 percentage points between June 212 and June 213 (Figure 2.B1). There were improvements in in most jurisdictions and and remoteness areas (Figure 2.B1). There were improvements in most jurisdictions and remoteness areas Twenty-eight (figures 2.B1 2.B1 (28) and and 2.B2). achieved 1%. (figures 2.B1 and 2.B2). Eighteen Organisation (18) performance did not (Figure record 2.B3): birthweight for any babies born. Organisation performance (Figure 2.B3): The top 25% recorded birthweight for 88% or more their clients. Twenty-eight (28) (28) achieved 1%. Twenty-eight The bottom 25% (28) recorded achieved birthweight 1%. for 22% or fewer their clients. Eighteen (18) (18) did did not not record birthweight for for any any babies born. Eighteen (18) did not record birthweight for any babies born. Variation The The top in top recording 25% 25% between recorded was large, birthweight with substantial for for 88% 88% numbers or or more recording their birthweight clients. either The for 1% babies 9 1% (Figure 2.B3). Substantial variation in recording is also seen by The The top 25% bottom 25% 25% recorded recorded birthweight birthweight for for 88% for 22% 22% or more or or fewer their their clients. clients. jurisdiction and by remoteness region (figures 2.B4 and 2.B5). The Variation bottom in in 25% recording between recorded birthweight was was large, with for 22% substantial or fewer numbers their recording clients. Variation Organisation birthweight in recording size either (indicated for for between 1% by number babies regular 9 1% clients) was had large, (Figure no clear with 2.B3). relationship substantial Substantial with numbers performance variation recording (Figure A5.1). birthweight recording either is is also also for seen 1% by by jurisdiction babies and or and 9 1% by by remoteness (Figure region 2.B3). (figures Substantial 2.B4 2.B4 and and variation 2.B5). in recording Organisation also size seen size (indicated by jurisdiction by by number and by remoteness regular clients) region had had no (figures no clear 2.B4 relationship and 2.B5). with Organisation performance size (Figure (indicated A5.1). by number regular clients) had no clear relationship with performance (Figure A5.1). Per cent Jun Jun Dec Dec Jun Jun Jun 212 Dec 212 Jun NSW & Vic & 42 Qld WA SA 5 NT NSW & Vic & 3945 Qld WA 48 SA NT National ACT ACT Tas Tas Figure NSW & 2.B1: Vic & Birthweight recorded, by by Figure ACT 2.B1: Tas Birthweight recorded, by jurisdiction jurisdiction Figure 2.B1: Birthweight recorded, by jurisdiction Number Qld WA SA NT National Per cent Jun Jun Dec Dec Jun Jun Per 8 8cent Jun 212 Dec 212 Jun Major 455 Inner Outer Very Major Inner Outer 354 Remote Very cities cities regional regional remote remote Figure Major 2.B2: Birthweight Inner Outer recorded, Remote by by Figure cities 2.B2: Birthweight regional regional recorded, by remoteness remoteness Figure 2.B2: Birthweight recorded, by remoteness Distribution Upper Upper quartile boundary (88.4%) Median organisation (63.6%) Lower Lower quartile boundary (21.9%) 6 6 National per per cent cent clients clients (58.1%) Number Distribution Upper quartile boundary (88.4%) Median organisation (63.6%) Lower quartile boundary (21.9%) National per cent clients (58.1%) <1 <1 1 <2 2 <3 3 <4 4 <5 5 <6 6 < <8 8 < Per Per 6 cent cent Figure 2.B3: Distribution percentage birthweights recorded, by by organisation <1 1 <2 2 <3 3 <4 4 <5 5 <6 6 <7 7 <8 8 <9 9 1 Figure Figure 2.B3: 2.B3: Distribution Distribution percentage percentage birthweights birthweights recorded, recorded, by organisation by organisation Very remote <Publication title title [footer double-click to to insert]> National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: first national results June 212 to June 213
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