News

Sweeping changes proposed to key indicator of general practice quality


Doug Hendrie


5/10/2018 3:21:10 PM

An RACGP–AIHW collaboration has led to major improvements to the Potentially Preventable Hospitalisations indicator.

Updates are designed to make the Potentially Preventable Hospitalisations indicator more comprehensive, accurate, trustworthy, current and focused on general practice.
Updates are designed to make the Potentially Preventable Hospitalisations indicator more comprehensive, accurate, trustworthy, current and focused on general practice.

The ‘flawed’ national indicator measuring quality of general practice is set to undergo sweeping change after a three-year collaboration between the RACGP and the Australian Institute of Health and Welfare (AIHW).
 
The two organisations have made major improvements to the often-criticised Potentially Preventable Hospitalisations (PPH) indicator in a bid to make it more comprehensive, accurate, trustworthy, current and focused on general practice. The proposed new PPH indicator is currently out for consultation.
 
Australian governments and agencies have used the PPH indicator for decades by to gauge the quality of general practice care. But the major drawbacks of the indicator were listed in a 2017 guide by the Australian Commission on Safety and Quality in Healthcare (ACSQHC).
 
‘A key limitation is that not all of the hospitalisations captured by the indicator could have been prevented, at least in the short term … Conversely, the current specification does not include all conditions which could potentially be used to measure the number of potentially preventable hospitalisations,’ the guide states.
 
Dr Evan Ackermann, outgoing Chair of the RACGP’s Expert Committee – Quality Care (REC–QC), has been the RACGP’s clinical lead on the collaboration to update the indicator.
 
‘Preventive care is a key aspect of general practice and a key part of the health system. This revised indicator is specific to general practice,’ he told newsGP
 
‘The previous indicator has been used for 30 years by governments, Primary Health Networks and the Productivity Commission, but it’s flawed.
 
‘Coding practices have changed, admission practices in hospitals have changed, funding models have changed, the ways patients are admitted had changed. The reality was, a lot of conditions being coded [as preventable] weren’t preventable at all.
 
‘We went through a comprehensive cleaning process, getting rid of conditions that weren’t preventable and adding those that were.
 
‘The project set out to address all of the criticisms, to update the indicator so that it was trustworthy, reliable, and would reflect health conditions relevant to general practice.
 
‘It was a major undertaking, reviewing coding practices and medical conditions.’
 
Dr Ackermann said early results from applying the new indicator show that general practice is performing well as a sector, but more needs to be done. He said the new indicator has already proven its worth by showing that over-treatment of diabetes is leading to a spike in potentially preventable hospitalisations for hypoglycaemia.
 
The AIHW has employed the proposed new indicator to derive indicative new rates of PPHs nationally, showing that admissions for vaccine-preventable conditions and acute respiratory conditions have decreased over the last decade.
 
But hospitalisations from acute skin conditions, chronic respiratory conditions, chronic mental health conditions, and chronic cardiac conditions have all risen over the same period.
 
Dr Ackermann said that the new indicator will eventually allow Primary Health Networks to drill down in the data to find out which PPHs are unusually high in their area and tailor their responses to the need. 
 
Dr Ackermann will release more detailed results during a presentation at the upcoming GP18 conference.



AIHW indicator Potentially Preventable Hospitalisations preventive care





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