This report presents data for 19 ‘process of care’ and ‘health outcomes’ indicators which focus on the prevention and management of chronic disease, and maternal and child health, Aboriginal and Torres Strait Islander people.
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 2012, and presents data analysed at the national level by jurisdiction, remoteness, and organisational size. The data are collected from over 200 primary health-care organisations receiving funding from the Australian Government Department of Health to provide services primarily to Aboriginal and Torres Strait Islander people.
The purpose of the nKPIs is to improve the delivery of 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 of closing the gap in life expectancy between Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians.
The nKPIs provide information on both 'process of care' indicators and 'health outcomes' for clients. The former are largely under the control of organisations and indicate good practice in primary health care. Health outcomes are influenced by the work of primary health care; however, they are also influenced by socioeconomic factors such as education, employment, income and housing, which are beyond the immediate control of primary health-care organisations.
A progress summary of the 19 nKPIs is shown at Table S1.
For the three reporting periods covered by this report (those ending in June 2012, December 2012 and June 2013), improvements were seen for most of the process of care indicators. The national proportions increased by 5-9 percentage points for the following five indicators:
- proportion of babies with birthweight recorded
- Medical Benefits Schedule health assessments for adults
- clients with type 2 diabetes who received a Team Care Arrangement
- recording of smoking status
- recording of alcohol use status.
The analyses of data by jurisdiction indicated that organisations in Queensland and the Northern Territory performed better against almost all process of care indicators. This may be due to these jurisdictions having well-established CQI programs that encouraged the development of and reporting against KPIs for several years before the start of the nKPIs.
Organisations with a small number of clients per general practitioner performed better against a large number of indicator measures. Smaller organisations (those with a small number of clients) did better than those with more clients on several indicators, including clients aged 50 and over immunised against influenza and HbA1c results recorded.
These early results have important implications:
- They show that improvements have occurred across most process of 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 organisations with better performance are spread across diverse geographic and service delivery environments. Small organisations can and often do perform well, as do larger organisations.
- 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 of 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 of informing their CQI activities. For some organisations, prompt action is indicated to identify the reasons for poor results and to develop strategies to improve the quality of services they provide.
- The report shows a number of key issues that require further investigation and/or development to inform the continuing improvement of the nKPI system itself. These include the possible development of benchmarks, and investigation of the robustness of current data gathering and recording processes in areas such as immunisation and kidney function tests. The report also highlights the need for further development of a CQI system that supports organisations in improving the delivery of primary health-care services for Aboriginal and Torres Strait Islander people.