Patient safety and good care is reliant upon continuous quality improvement.
Key requirements for quality improvement:
- The improvement is informed by data, so the impact of changes can be measured. Data can be drawn from a variety of sources, including feedback from patients, team members in the practice, and clinical data analysis.
- All members of the team are involved on a routine basis.
The Quadruple Aim is a term to describe four domains to consider when improving something:
- Patients' experience of care
- Clinicians' experience of work
- Improved health outcomes for patients
- Sustainable cost
If you're struggling to decide what to do, narrow your options down to those that fit within all four of these dimensions, because anything that fits in all four is more likely to get everyone engaged and motivated.
A model for quality improvement is available and comprises three essential questions as well as an overview of Plan, Do, Study, Action (PDSA) cycles to help structure your approach.
Find a SEMPHN PDSA template.
What to measure: outputs vs outcomes
You can measure outputs (e.g. the number of Type 2 Diabetes patients who have had a recent HbA1C).
Or you can measure outcomes (e.g. more Type 2 Diabetes patients who are controlled, which could be measured by counting, over time, those with a recent HbA1C in target range).
Measuring outcomes is the recommended choice. It's more meaningful to everyone, and it's more important because it's measuring what you're trying to achieve.
Here is an example of some outcome measures you might want to track:
- % patients with Type 2 Diabetes who are controlled (HbA1c < n)
- % patients with IHD/CHD who are on anti-platelets
- % [at-risk patient cohort] who have had a flu vaccine
- trend in eGFR of patients with CKD (i.e. how many maintained renal function)
Tracking measures and data analysis
Once you've picked an important outcome measure, how do you track it?
Practice Incentive Payment Quality Improvement (PIP QI)
The Practice Incentive Payment Quality Improvement (or PIP QI) is for general practices that participate in quality improvement activities to improve patient outcomes and deliver best practice care.
There are two requirements that practices must comply with in order to receive payment:
- Participate in continuous quality improvement each quarter (such as PDSA activities), in partnership with their local PHN. The measure for the activity must be from clinical data.
- Submit the PIP Eligible Data Set on a quarterly basis to their local PHN.
More information and the Guidelines for PIP QI are on the
Department of Health webpage for PIP QI Incentive guidance.
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How can my practice register for PIP QI?
Register via HPOS (using PRODA).
The steps in HPOS are:
- Log on to HPOS
- Click My Programs
- Go to the PIP tile
- Click the Update button
- The Program and PIP information screen will appear
- Click the Exit button at the bottom of the information
- Look for the Main menu (red header at top-left of screen), and click Incentive summary
- In the Quality Stream section > Quality Improvement Incentive, click the Apply link
- Read the terms.
- Tick the Participation Payment option
- Click Submit
Important note: once you've registered, you must email your SEMPHN Provider Support Officer to tell us that you've registered and what your PIP Practice ID is.
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What are the 10 eligible data set metrics for PIP QI?
The Eligible Data Set comprises fields required to calculate 10 metrics and analyse them according to the PIP QI Data Governance Framework.
The 10 metrics 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
If you would like support for your practice, contact your Provider Support Officer, or email providersupport@semphn.org.au.
South Eastern Melbourne PHN
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