Quality Improvement and PIP QI
Quality in general practice
Practices need to engage in activities to improve quality and safety for patients in areas such as practice structures, systems, processes and clinical care.
The RACGP standards for general practice indicate focusing on quality improvement should be based on evidence produced from the practice's own data.
One way this can be gathered is data audit and analysis from the practice’s clinical database, using a clinical audit data extraction tool. Measuring quality focuses on a multi-dimensional approach of the interactions between structure, process and outcomes.
The Quality Improvement PIP Incentive commenced on 1 August 2019.
This PIP is designed to encourage improvements in quality care, enhance capacity, improve access to care and improve health outcomes for patients.
As part of the new PIP QI Incentive, you’ll have to undertake continuous quality improvement activities through the collection and review of your practice data or information.The QI PIP will replace the following incentives:
- Asthma Incentive
- Cervical Screening Incentive
- Diabetes Incentive
- Quality Prescribing Incentive
The following incentives will stay the same:
- eHealth Incentive
- After Hours Incentive
- Teaching Payment
- Indigenous Health Incentive
- Procedural General Practitioner Payment
- Rural Loading Incentive
- General Practitioner Aged Care Access Incentive
pdf Click here (517 KB) for the latest fact sheet regarding what practices need to know - August 2019
Click here for the latest information regarding the new Quality Improvement PIP.
Quality Improvement generally follows these simple steps:
- Utilise data extraction tool to conduct clinical audit
- Record outcomes of clinical audit
- Document proposed actions following clinical audit, including delegated responsibilities
- Keep evidence of implementation
- Document follow up plans
- pdf (266 KB) Sample pdf CESPHN QIA BMI recording Level 1 (359 KB)
- Blank Quality Improvemnt Plan pdf QIA Final Planning Sheet (376 KB)
The 10 Quality Improvement Measures (QIM’s)
As part of the new PIP QI, participating practices (insert link to how to enrol) must share the following data with the CESPHN. This data is known as the Quality Improvement Measures (QIM).
Practices must also commit to Continuous Quality Improvement (CQI)(insert link to fact sheet) based on one of the QIMs or any other QI Activity that is based on data from the practice electronic medical records (EMR)
The 10 QIMs are:
- Proportion of patients with diabetes with a current HbA1c result
- Proportion of patients with a smoking status
- Proportion of patients with a weight classification
- Proportion of patients aged 65 and over who were immunised against influenza
- Proportion of patients with diabetes who were immunised against influenza
- Proportion of patients with COPD who were immunised against influenza
- Proportion of patients with an alcohol consumption status
- Proportion of patients with the necessary risk factors assessed to enable CVD
- Proportion of female patients with an up-to-date cervical screening
- Proportion of patients with diabetes with a blood pressure result.
New to QI
Before you commence your clinical data quality improvements, you may want to start with our “Beginners - Level 0” QI Activities (QIA’s). These activities will help to build the team, cleanse your data and generally make you familiar with quality improvement terminology and process. You can then progress to our higher level QIA’s, that are designed to build on lower level activities. The Beginners QIA’s will help you establish a “Person Centred” (insert link to PCMN page) approach to your patients.
To assist your practice in meeting the requirement of maintaining evidence that CQI activities have been undertaken, we have developed a new suite of templates and tools for your practice to get started with. Our QIA’s are based on the 10 QIM’s and are designed to build on the outcomes from the lower level QIA. We welcome any feedback or suggestions you might have to improve these templates.
Level 1 QIA’s can generally be carried out by non-clinical staff at the front desk and generally focus on demographics or data cleansing especially current contact details.
Level 2 may involve the nurse or a GP leader and require some clinical skill and access to patient files.
Level 3 tend to focus on patient outcomes and will require GP participation, preferably practice wide.
We will continue to develop the Walk Throughs (POLAR) and Recipes (Pen CAT) that will step you through the use of the extraction tools to develop the reports we refer to in the templates. Both websites have substantial resources available, and we encourage you to refer to them directly.
POLAR users Confluence Health log in
Pen CAT Pen CAT Recipes
Our dedicated Quality Improvement Officers Sara and Thuy Ann are here to help so please get in touch with them.
Sara Matin E: s.matin@cesphn.com.au M: 0448 377 230
Thuy Ann Vuong E: t.vuong@cesphn.com.auM: 0439 137 818
Quality Improvement Activity Templates
|
Quality Improvement Measure (QIM) No |
Name |
Level |
|
Diabetes (1) |
Find diabetics without a usual GP |
1 |
|
Update the diabetic register |
2 |
|
|
Recall patients without a HbA1c |
3 |
|
|
Diabetes (5) |
Find diabetic patients who have not been immunised against influenza |
3 |
|
Diabetes (10) |
Find diabetics without a current blood pressure result pdf CESPHN QIA Diabetes without blood pressure Level 2 (367 KB) |
2 |
|
Find diabetics with three of less missing items to complete their cycle of care |
3 |
|
|
Smoking (2) |
Improve the recording of patient smoking status |
1 |
|
Identify pregnant women who are current smokers |
2 |
|
|
Identify current smokers with COPD and of CVD |
3 |
|
|
Weight (3) |
Improve the recording of patient BMI |
1 |
|
Find obese patients who might be eligible for a Health Assessment |
2 |
|
|
Find patients with a BMI over 30 and are type 2 diabetic or a current smoker |
3 |
|
|
Influenza vaccination (4) |
Improve the recording of patients 65+ years and immunised against influenza pdf CESPHN QIA 65 and immunised against influenza level 2 (359 KB)
|
2 |
|
Influenza vaccination (6) |
Improve the recording of patients with COPD and immunised and immunised against influenza
|
2 |
|
Alcohol (7) |
Improve the recording of patient alcohol consumption
|
1 |
|
Reduce alcohol consumption in patients with a mental health condition |
2 |
|
|
Reduce alcohol consumption in hypertensive patients |
3 |
|
|
CVD risk (8) |
Improve the recording of patients with necessary risk factors to enable CVD assessment |
3 |
|
Cervical Screening (9) |
Improve the cervical screening rates in female patients |
3 |
For those practices interested in pursuing QI at a higher level, CESPHN offers many programmes of different complexities to support practices. Some of these programmes have financial incentives.
They Include:
My Health Record
Shared Health Summary uploads for eHealth PIP
Contact: Digital Health Team (digitalhealth@cesphn.com.au)
Mental Health
Black Dog StepCare Program
Contact: Catherine O’Donnell (c.odonnell@cesphn.com.au)
Population Health & Chronic Disease
Staying Health Living Well Telehealth Program
Contact: Jason Phillips (j.phillips@cesphn.com.au)
Please see the Person Centred Medical Neighbourhood page here.
Quality health records are essential to all practices. They facilitate the safe, accurate sharing of health information between health professionals to achieve safe and effective patient care.
The auditing of your practice’s data, processes and systems is important. The audit outcomes can indicate target areas for health record QI, such as:
- completeness of content in patient health records like allergy status, smoking status and other health summary information
- consistency in standardising processes for entering data in line with a nationally recognised coding system
- the ability to access, share and retrieve recorded information in a timely manner
For further information see the links below
Improving health record quality in general practice
Quality records in Australian primary healthcare
Practices can focus on activities specifically designed to improve individual care or the health of their entire practice population. For example, a clinical QI activity could focus on improving the care of individuals with diabetes.
Data extraction tools are designed to make analysis of your data as simple and as easy as possible. It lets you look for sources of revenue, build and maintain disease registers and even highlight coding errors. These tools are essential for helping your practice profitability and your patient care. CESPHN supports practices that use Pencat and now offers Polar as an alternative data extraction tool.
At this stage if you want to participate in the new QIP you must upload your de-identified data base to CESPHN. At no point does any identifiable patient data leave your practice. The data extraction tool deidentifies your data at your practice and sends the encrypted data securely to us. It does not upload any of your financial information. Privacy is our top priority. Depending on which extraction tool you use and how it is set up, your data may be uploaded automatically. Contact your Practice Support Officer for more information.
If you need a copy of the Pen CAT privacy notice for your practice pdf click here (930 KB) or the POLAR privacy notice, pdf click here (130 KB) .
- Strategies to embed QI in your practice
- How to analyse your practices own data to identify areas for QI
- Assist with goal setting and activities
- Measuring quality improvement in your practice
- Progress reports and feedback
- For further information please contact our Quality Improvement Officers on 1300 986 991, press 2 or email pipqi@cesphn.com.au
- pdf (1.44 MB) pdf How to Apply for PIP QI and PRODA (1.44 MB)
- pdf Bodenheimer’s Ten Building Blocks of High Performing Healthcare (537 KB)
- pdf The Quadruple Aims (475 KB)
- Quality and Safety - RACGP Curriculum for Australian general practice 2016
- The RACGP Green Book
- APNA Setting up a nurse run clinic
- Quality Improvement Activities - RACGP Standards for general practices (5th edition)
- Australian Safety and Quality Framework for Health Care - Australian Commission on Safety and Quality in Health Care
- Australian Family Physician - RACGP
- Sample compliance checklist for quality health records – RACGP
- Governance for Safety and Quality in Health Service Organisations Factsheet - Australian Commission on Safety and Quality in Health Care
- Governance for Safety and Quality in Health Service Organisations Standard 1 - Australian Commission on Safety and Quality in Health Care
- Clinical Governance for Managers and Clinician Managers
- Just a GP multilayerd podcasts for a multilayered profession #7 Improving quality in general practice (you will need Itunes installed)