Quality Improvement and PIP QI
Quality improvement 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.
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
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 (CQI) activities through the collection and review of your practice data or information.
The PIP QI 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
The 10 Quality Improvement Measures (QIMs)
As part of the new PIP QI, participating practices must share the following data with the CESPHN. This data is known as the Quality Improvement Measures (QIM).
Practices must also commit to CQI 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 assessment
- Proportion of female patients with an up-to-date cervical screening
- Proportion of patients with diabetes with a blood pressure result
pdf Click here (597 KB) to view the PIP QI report walk through.
To participate in PIP QI, practices must:
- Be an accredited practice
- Have a data extraction tool installed in the practice (CESPHN supports Pen CAT & POLAR)
- Share de-identified data with CESPHN (for PEN this includes a scheduler)
- Sign applicable Data Management Agreements (DMAs) ( pdf Pen CAT (429 KB) / document POLAR (65 KB) ) and have the appropriate posters ( pdf Pen CAT (599 KB) / pdf POLAR (2.74 MB) ) visible in the practice
- Register from 1 August via PRODA and HPOS
- Complete an annual confirmation statement each year
- Notify CESPHN you have applied for the PIP QI incentive and provide your PIP Identifier Number (PIPIN) – this is so we can assist the department in processing payments
- Provide the main contact person for the program including 2 email address to receive the quarterly benchmarking report
- Submit the PIP Eligible Data set to CESPHN on a quarterly basis (CESPHN will extract submission data on a monthly basis)
- Work in partnership with CESPHN on practice relevant Quality Improvement activities (QIAs)
- Retain evidence (for 6 years) of the QI activities you have undertaken in the practice
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
pdf Click here (1.44 MB) for our manual on registering for PRODA and PIP QI
pdf Click here (247 KB) for our PIP QI & Data Sharing FAQ Sheet
pdf Click here (38 KB) for the PIP QI factsheet for consumers
Your patients have the right to request that their information is permanently excluded from the practice’s de-identified data set. Simple step-by-step guides on how to exclude the patient are available:
pdf Pen CS - How to opt out patients (172 KB)
pdf POLAR - How to opt out patients (515 KB)
Not an accredited practice but would like to enrol in PIP QI?
If you would like to participate in the new Quality Improvement (PIP QI) Incentive but are not an accredited practice, our Practice Support and Development team can help you through the accreditation process. The Practice Support team can be contacted on practicesupport@cesphn.com.au or call 1300 986 991 and press 3.
Practice support can also support your practice with:
- Staff orientation of general practice staff including GPs, GP Registrars and Practice Nurses
- Practice Incentive Programs (PIPs), Service Incentive Program (SIPs), MBS items and Chronic Disease Management (CDM) items.
- Undertaking quality management practices in accordance with best practice and appropriate accreditation standards
- Advice based upon industry knowledge and legislative changes and emerging trends.
Time Limit Exemption
General practices who wish to participate in the PIP QI incentive but do not wish to use Pen CAT or POLAR as their preferred tool to share data can submit a pdf Time Limit Exemption form (484 KB) to the Department of Health for review and approval. This gives practices 12 months to work in partnership with their local PHN to meet the other requirements of the PIP QI Incentive without the need to share any data, and they will still receive quarterly payments.
For more information please read the attached pdf factsheet (377 KB) .
To assist your practice in meeting the requirement to maintain evidence that CQI activities have been undertaken, we have developed a new suite of sample templates and tools for your practice to get started with as a guide. Our QIAs are based on the 10 QIMs, are classified as Level 0, 1, 2 or 3 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 0 - We recommend starting with these activities which will help build the team, cleanse your data to prepare you for the higher level activities and familiarise you with quality improvement terminology and processes. These will help you establish a “Person Centred” approach to your patients.
Level 1 - 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 - Tends to focus on patient outcomes and will require GP participation, preferably practice wide.
We will continue to develop the walkthroughs (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 users: Pen CAT Recipes
For more information contact pipqi@cesphn.com.au
Quality Improvement Activity Templates
We have created a Quality Improvement Template for you to download and use:
pdf CESPHN's Blank Quality Improvement Activity Template (376 KB) (editable PDF version)
document CESPHN's Blank Quality Improvement Activity Template (442 KB) (Word version)
Level 0 (Getting Started):
pdf Building the quality improvement team (359 KB)
pdf Finding duplicate patients (359 KB)
pdf Cleaning up the active patients registry (359 KB)
pdf Improving the coding of diagnoses (359 KB)
pdf Updating patient demographics (359 KB)
pdf Improving the recording of patient allergy (359 KB)
pdf MD - Configure user options to help maintain data quality (278 KB)
pdf BP - Configure user options to help maintain data quality (245 KB)
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.
These include:
My Health Record
pdf QIA - Shared Health Summary uploads for eHealth PIP (359 KB)
Contact: Digital Health Team (digitalhealth@cesphn.com.au)
Lumos
QIA - Use Lumos Report to Improve Coding of “Undiagnosed” Diabetics
Contact: Digital Health Team (digitalhealth@cesphn.com.au)
Mental Health
pdf QIA Level 1 - Mental Health Screening (359 KB)
pdf QIA Level 2 - Mental Health Treatment Plan (359 KB)
pdf QIA Level 3 - Mental Health Treatment Plan Review (365 KB)
Contact: Abhishek Paudel (a.paudel@cesphn.com.au) or Jen Aboki (j.aboki@cesphn.com.au)
Population Health & Chronic Disease
Diabetes cycle of care: Diabetes foot assessment - QIA Level 1
Referring diabetic patients to the High Risk Foot Service (HRFS) - QIA Level 2
Lifestyle Modification
Think, Eat And Move (TEAM) Program
pdf QIA - Referring patients to the TEAM Program (360 KB)
Sexual Health
Self-collected specimens for Chlamydia testing in your practice (QIA Level 1)
Contact: Phoebe Chomley (p.chomley@cesphn.com.au)
Maternal & Child Health
document QIA - Increasing influenza vaccination uptake in pregnant women (443 KB)
document QIA - Increasing pertussis vaccination uptake in pregnant women (443 KB)
Contacts: Karen Wheeler (k.wheeler@cesphn.com.au) or Jane Miller (j.miller@cesphn.com.au)
Immunisation
AIR10A Due/Overdue Immunisation Practice Report
How to request AIR Due/Overdue 10A Report
How to analyse AIR Due/Overdue 10A Report
pdf QIA - Using AIR 10A report to improve immunisation rates (360 KB)
Contact: Immunisation Team (immunisation@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 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)