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NT AHKPI Frequently Asked Questions FAQs
What are the NT AHKPIs?
A Key Performance Indicator, or a KPI, is a measurement of performance
It indicates how well you are doing against a specific indicator
It’s like a report card – it tells you where you are doing well and where there are gaps
Background/ History
Over 10 years of consultation and work went into developing the NT AHKPIs.
“Development of a Performance Reporting System for Indigenous Primary Health Care” https://health.nt.gov.au/professionals/aboriginal-health-key-performance- indicator
NT was the first State/Territory to have a set of KPIs specifically for Aboriginal PHC
What Governance Model supports the NT AHKPIs?
The Northern Territory Aboriginal Health Forum (NT AHF) - comprises senior
representatives from the Australian Government Department of Health (DoH), the
Aboriginal Medical Services Alliance of the NT (AMSANT) and the NT Department of Health (NT DoH). The Forum’s role is to provide advice and direction on Aboriginal health issues.
The NT AHF provided leadership in the development and implementation of the Key Performance Indicators and the NT AHKPI system.
The Chair of the NT AHF is the Sponsor of the NT AHKPI data collection. This role has been delegated to the NT AHKPI Steering Committee.
NT AHKPI Steering Committee (SC) - consists of representatives of the three NT AHF
partners and has been delegated the role of NT AHKPI Data Collection Sponsor. It provides high level advice to the NT AHF with the overall aim of improving the generation and
strategic use of NT AHKPI data to improve health outcomes through the Aboriginal PHC system.
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NT AHKPI Technical Working Group (TWG) - reports to the Steering Committee and consists of representatives of each of the NT AHF partners. The role of the TWG is to review the implementation of the NT AHKPIs and make recommendations to the SC on technical issues that must be addressed in order to ensure that funders, health boards and management can receive timely and accurate reports from data extracted from all Patient Information Recall Systems (PIRS) across the NT.
NT AHKPI Clinical Reference Group (CRG) - reports to the Steering Committee and consists of representatives of each of the NT AHF partners. The role of the CRG is to review the results of the NT AHKPIs for their clinical relevance and as a tool in clinical CQI activities.
The CRG also make recommendations to the Steering Committee on changes needed to ensure that the NT AHKPIs provide the required feedback to clinicians, funders, health boards and management.
What are the Aims and Objectives of the NT AHKPIs?
To inform planning for PHC service delivery
To inform continuous quality improvement (CQI) activities
To inform understanding of trends in individual and population health outcomes
To identify factors influencing these trends
To inform appropriate action, planning, service improvement and policy development
To inform community engagement and health awareness raising activities
How are PHC Services using their NT AHKPI reports?
For CQI Action and Planning
o The NT AHKPI data can identify areas of strength by highlighting where your service is doing well. The data can also identify gaps in service delivery, where changes to practice are needed
Measurement to inform health service planning and delivery
o Measurement through the NT AHKPIs provides you with evidence of how your service is tracking against this set of indicators
o The NT AHKPI data will help to inform your Health Service where you are doing well and where there are gaps in service delivery
o The NT AHKPI data can help you strategically plan where improvements are required to your systems or where you will focus your quality improvement activity
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Interpretation and Analysis – team approach
o Interpreting and analysing the graphs and tables in the NT AHKPI Report enables each PHC service to “make sense” of the information in the report in their local context
o This interpretation and analysis of the NT AHKPI data is often most effectively done by involving the PHC team in this process
Accurate record keeping
o Reinforces the importance of accurate record keeping and documentation in your Clinical Information System eg Communicare or PCIS
o Reinforces the use of correct clinical items or service items so the information entered in the CIS can be extracted in reports
Impact of changes
o It provides evidence on the impact of changes made to service delivery o It provides evidence as to whether the change to practice had the desired
result, whether it brought about an improvement and helps in deciding whether you need to revisit your actions
Benchmarking
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Data allows your health service to make comparisons with others; local, regional or national data/reports. Trends over time
o The data shows you trends over time o It demonstrates variation over time
o It allows you to ask, “Is there a story behind the ups and downs?”
o It prompts you to ask, “What’s causing these ups and downs?”
o It encourages you to ask, “What’s the story behind the data?”
Health outcomes/Health gains:
o Your NT AHKPI report can show whether the health outcomes of your community are improving. E.g., are the rates of anaemia decreasing? Or, is HbA1c improving? etc.
Feedback/Conversations with boards
o The NT AHKPIs can provide valuable feedback and discussion points that can be used with your board or community groups or members.
o How do you provide feedback to the community?
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How else is the NT AHKPI Data used?
Data Sharing
The NT CQI Collaborative data provides a forum where PHC services can present their NT AHKPI data with the aim of identifying successful actions for improvement that can be shared across all services and to discuss potential strategies to address gaps and areas of concern highlighted by the data. Sharing data between services and clinical leaders can be very useful in trouble shooting problems and identifying solutions, assessing system issues that affect multiple services and identifying and sharing strategies that have been useful in improving outcomes.
The CQI Data WG
A small CQI Data Working Group has been established under the directive of the NTAHF and AMSANT Board. The aim of the WG of CQI experts to look at the identified NTAHF KPI Data at service level across the NT from both ACCHS and NTG PHC services for the following purposes:
To identify services/HSDA who are doing particularly well in a KPI as this will provide an opportunity to translate their knowledge/expertise/systems more broadly.
To identify areas of need in one or more services. To enable more targeted support and training or to translate learnings from areas doing well on specific KPIs.
To identify KPIs/topics for a CQI focus through the CQI Collaborative and CQI Facilitator support
What is a client?
The NT AHKPI collects data on clients from your Clinical Information System (CIS) – Communicare or PCIS.
Therefore a ‘client’ is a person who has visited the health centre, has received health care and this has been recorded in your CIS.
A client will be a regular client or visitor (please refer to the definition of a regular and visitor client)
A regular client or resident is an individual who is identified as a regular client of the health service, usually the client resides in the community serviced by the health centre, and commonly has had some contact with the health service in the previous 2 years.
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Regular client definition Effect on denominator/ who is included/excluded
NT AHKPI
Identified as such by health service;
usually the client resides in the community and commonly has had some contact with the health service in the previous 2 years
Includes clients who live in your community, who have been seen at least once in 2 years (or is identified as such by your service)
Excludes visitors
Visitor definition A visitor is an individual who has been seen in your health service but who lives outside the locality serviced by your health centre.
What is a client contact?
When someone receives health care from a health professional at your health centre it is called a ‘client contact’.
Single client contact: If a client receives health care from one health professional at a health centre on one day it is one client contact.
More than one contact: If a client receives health care from more than one health professional on one day it is more than one client contact. For example if a client saw 3 different health professionals on one day it would equal 3 client contacts (1 doctor, 1 nurse, 1 Aboriginal health practitioner).
When we count client contacts we are counting all contacts made in the CIS for your health centre during the reporting period.
What is an episode of care?
Each time a client sees a health professional at the health centre it is called an episode. If a client sees more than one health professional on the same day it is called one episode.
Single client contact One episode
More than one contact in one day e.g.
sees the doctor, nurse and AHW (3 contacts)
One episode
Client returns to health service with a different problem i.e., has been twice to health service on the same day with separate health problems
Two episodes
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All client episodes are counted for the reporting period.
What is a numerator and denominator?
Numerator:
The number of episodes of health care during reporting period
The number of client contacts during reporting period.
Denominator:
The resident population count as at the end of the reporting period.
Example: AHKPI 1.1 Episodes of Health Care and Client Contacts Numerator
The number of episodes of health care during reporting period.
The number of client contacts during reporting period.
Denominator
The resident population count as at the end of the reporting period.
Each client is counted only once. For instance NT AHKPIs 1.8.1 and 1.8.2 we need to know the number of clients who have diabetes recorded in the CIS and these are clients that live in your health service area and are recognised as a resident or regular client who attends your health centre. The total number of people with diabetes are the denominator for AHKPIs 1.8.1 and 1.8.2.
What is a reporting period?
The reporting period is commonly 12 months, unless otherwise specified. This is one calendar or financial year, depending on the reporting cycle. For example:
AHKPI 1.1 counts all contacts and episodes of care for the previous 12 months – one reporting period.
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AHKPI 1.7 counts CDMPs for one and two reporting periods (previous one and two years) as CDMPs are valid for 2 years
AHKPI 1.8.1 counts HbA1cs measured for 6 months and 12 months as HbA1c measurement is recommended 6 monthly for people with diabetes
What do we mean by Health Service Area (HSA)?
All localities that are serviced by your health centre/ service combined together is your health service area (HSA). Your CIS will be set up to group the localities determined by you so information of your clients that live in these localities are grouped together.
Grouping localities into a HSA is used more by larger health services, therefore
Smaller services might just have a locality where the health centre is situated. A HSA is also used to determine who you provide health service to and the people that live in this HSA are the people you would be funded to provide primary health care to as they are your resident clients.
How is data reported for the KPIs?
Every time you see a client and record information about that client in your CIS that information or data can later be extracted by running reports. To enable data to be extracted for reporting purposes the information must be entered in the right places in your CIS, using clinical items or service items and not using free text.
The NT AHKPI data is uploaded from each service provider to the secure NT AHKPI data base in the Northern Territory Department of Health (NT DoH) Data Warehouse via the website (http://www.nt.gov.au/health/ahkpi/).
Why do we get different results between the NT AHKPI data and other data sources such as the national key performance indicators (nKPIs) and the Online Services Report (OSR)?
Even though the definition of the key performance indicator might seem to be the same, there are differences in the definitions and counting rules which determines how the data is extracted from the CIS data base.
For instance, the OSR includes transport and excludes residential care.
Differences between the NT AHKPIs and the nKPIs
The nKPIs have a different definition of regular client.
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Regular client definition Effect on denominator/ who is included/excluded
NT AHKPI
Identified as such by health service;
usually the client resides in the community and commonly has had some contact with the health service in the previous 2 years
Includes clients who live in your community, who have been seen at least once in 2 years (or is identified as such by your service)
Excludes visitors National KPI
3 contacts with the health service in 2 years, regardless of where that client lives
Will include clients who live outside the community, but if visiting may have been seen by your health service 3 times in 2 years
Will exclude clients who live in your community, but have been seen less than 3 times in 2 years
Some indicators have slightly different definitions. For example:
KPI NT AHKPI National KPI
Birth weights
Includes multiple births Counts babies born to resident mothers
Excludes multiple births
Counts all babies recorded at the health service
Health checks
Includes alternative health checks
Counts from age 0 years and above
Counts only MBS item 715 claimed Include children aged 0-4 years
HbA1c Count from age 5 years and over
Count all ages from 0 years CDMPs Include people with
coronary heart disease and type 2 diabetes
Count MBS items 721 & 723 (GPMP & TCA)
Count only people with type 2 diabetes Count only MBS item 721 (GP
management plan)
Diabetes – BP control
Count from age 15 years and over
Count all ages from 0 years
Cervical screening
Includes women who have had hysterectomies
Excludes women who have had hysterectomies
CV risk Based on CARPA STM, starting at age 20 and adds 5% for Indigenous status
Based on Framingham and starting from age 35 and no added 5% for Indigenous status