Performance framework and performance indicators for Divisions of General Practice

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Performance framework and performance indicators
for Divisions of General Practice

• PHC RED Seminar
• Libby Kalucy 6 April 2005

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Overview

• Background
• National Quality Performance Framework
• Performance indicators
• Implications for research, researchers and
  academic departments

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1. Background
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Background (cont)
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2 National Quality Performance Framework

• Performance indicators for Divisions and SBOs.
• Program.
• Governance.
• Planning and reporting framework.
• PR proforma (instead of OBF template).
• Financial proforma.
• Accreditation, structural efficiencies, new
  funding agreement and development pool.

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2 National Quality Performance Framework
Purpose (1)

• Reflect government expectations of Network in
  defined priority areas
• Reduce variation in performance quality
• Provide evidence of what Divisions are
  contributing to community

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2 National Quality Performance Framework
Purpose (2)

• Enable aggregation of data to assess
  organisational health of Network, achievements
  and impact
• Provide evidence of value for money, and
  accountability to communities, general practices
  and general practitioners
• Inform future funding and policy decisions about
  Network

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3. Developing the indicators November 04 March
05

• Bev Sibthorpe at APHCRI, Australian National
  University led an expert technical group, with
  individual expert for each domain
• Consultation with working groups and Network
• Review of each set by national/international
  expert
• Alignment with other initiatives NPCC, RACGP,
  Diabetes Australia etc

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Gawaine Powell-Davies, Denise Ruth, Nick Glasgow
D. Longstaff
Jeff Richards, Bev Sibthorpe, John Glover
Libby Kalucy John Aloizos
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(No Transcript)
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Conceptual basis for primary health care
indicators

• PHC cannot be held solely accountable for health
  outcomes but PHC delivery makes major
  contribution to
• levels of health risk behaviours
• levels of clinical status measures
• levels of satisfaction with care
• in client populations.

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Measuring performance of Division Network

• Divisions do not control general practices but
  should be able to influence GPs and practices and
  the context in which they work.
• Divisions have been actively working for some
  years in the performance domains selected for
  national indicators.
• SBOs have specific domains relating to their
  state roles.
• The governance domain is common to all members of
  the Network.

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How to start?

• With a modest set from a few important domains of
  activity
• in the priority areas for strengthening primary
  health care stated by government in 2004
• where Divisions are already achieving
• where government has major investment

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3. Priority areas for primary health care (DoHA
2004)

• Access
• Integration
• Prevention/early intervention
• Chronic disease management
• General practice support
• Quality support
• Governance
• Consumer focus
• Workforce

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RIC selected some specific domains in 5 areas (1)

• Access
• Access to GP for residents in aged care homes
• Integration
• GP-hospital integration
• Prevention and early intervention
• Immunisation

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RIC selected some specific domains in 5 areas (2)

• Chronic disease management
• diabetes and/or
• asthma and/or
• mental health
• Governance
• organisational capability
• financial accountability
• governance

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Each indicator has been carefully defined

• Objective
• Rationale
• Type (quantitative, qualitative)
• Source of numerator, denominator
• Data coding
• Mechanism for QA on numerator, denominator
• Method for data transfer to collation agency
• Method for calculation of the indicator
• Timing of reporting
• Disaggregation (equity)

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Indicator framework has four levels (based on
Sibthorpe 2004)

• Divisions organisational structures and
  processes
• Organisational structures and processes for
  practices and GPs
• Processes of care for patients, families and
  communities
• Intermediate health outcomes
• (RIC information sheet National Performance
  Framework, November 2004)

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Forms of Level 1 indicators

• Division collaborates with stakeholders to
  make something happen for group of people
• Division takes a systematic approach to support
  GPs to do something
• Division facilitates access to effective CPD for
  care needs for patient group

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Forms of indicators levels 2-4

• Level 2 GP/practice level
• Number and proportion of gps or practices
  doing something
• Level 3 process of care level
• Rates of x by general practices
• Number and proportion of patients with x who
  y
• Level 4
• Number/proportion of patients recorded as
  current smoker/HbAIc level/cholesterol level

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Forms of indicators qualitative

• Half page description of a significant
  achievement.
• Description need not exceed half a page and must
  follow the format of aim, actions taken and
  outcomes.
• Statement of CPD relating to x provided by the
  Division.
• Brief description of the system not to exceed
  half a page.

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Data sources

• All sources and other essential information are
  clearly defined in technical information
  documents
• Data sources include
• Division records - eg from survey
• HIC
• DoHA

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Eg Priority area Manage Chronic Disease Domain
Asthma

• See handout of indicators relating to asthma
• Forms
• Levels
• Rationale and technical information
• Points system

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More about national performance indicators

• Some are compulsory.
• Some are worth more points than others.
• A minimum point score is set for 2005-6, for
  Divisions and for SBOs.
• Indicators are about moving forward in accordance
  with evidence for good practice.
• Purpose is accountability and performance
  improvement of Divisions and of Network.

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Indicators are only part of the reporting story

• Division context
• Explanatory text for each indicator
• Reflection on each objective
• Local objectives and indicators
• Local objectives in remaining four national
  priority areas

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4 Implications for research and evaluation

• Support materials for planning
• Data collection
• Data analysis and interpretation
• Performance information is only useful if it
  used, therefore
• Design effective ways to feedback information
• to Divisions
• to practices and GPs

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4 Implications for evaluation

• Process and outcome evaluation of these
  innovations
• How do Divisions engage /persuade GPs to provide
  practice information?
• Enablers and barriers in different contexts
• Confidentiality, ownership
• How is information used?
• Does NQPS lead to improved performance of
  Divisions and of general practice, and benefits
  for community? or
• does NQPS just increase the burden of data
  collection for everyone?

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Resources

• RIC communiques
• www.health.gov.au/pcd/programs/divisions/index.htm
  
• Division and SBO planning and reporting
  proformas
• http//www.phcris.org.au/resources/divisions/divis
  ion_resources_frameset.html
• Performance indicators and Technical information
  www.adgp.com.au

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Discussion
Reactions? Suggestions?