Quality Improvement in Primary Care Setting

In times of national health reform, primary health care services are required to be more responsive, meet safety and quality standards, prompt gap identification and facilitate multidisciplinary and better coordinated care. Therefore, a close and direct relationship between individuals, communities and their caregivers is required.

To this purpose, we provide organisations, teams and individual practitioners serving the health care needs of the community in the Western Sydney Medicare Local catchment, with the opportunity to apply for any of the following: 

 

• Australian Primary Care Collaboratives (APCC), funded by the Australian government, is the largest quality improvement program in Australia.  This program provides a systematic approach for the breaking down of large tasks into small manageable steps via Plan, Do, Study, Act (PDSA) cycles to sustain improvements in target areas.

• Practice Health Atlas™ (PHA): is a comprehensive business development tool containing epidemiology reports, mapping, income forecasts and strategies for linkages with local services. The PHA was evaluated by the University of Sydney during 2010 - 2011.  Findings reflected changes at a systems level in terms of clinical management behaviour producing improvements in data coding, recording, at risk patient identification as well as income. In time, these changes are expected to enhance patient outcomes. 

• Quality Practice Program (QPP): using the improvement methodology, QPP assists with the procurement of data quality monitoring software tools, needs assessments, metrics definition, providers quality indicators, audience stratification, resources optimisation and outcomes evaluation.

For queries or for more information on any of these programs, contact Alex McLaren on: alex.mclaren@wentwest.com.au

Taking your practice to a new level

A General Practice knows it is time to move to a new level when the minimum standards and processes ensure the systematic running of the practice has been achieved. These standards are prescribed in the 4th Ed RACGP Standards: http://www.racgp.org.au/standards and are described below but not limited to:

Practice Services	Physical Factors
Care outside normal opening hours; informed patient decisions; health promotion and preventative care; consistent evidence based practice; clinical hand over; follow up of test and results system; engaging with other services; comprehensiveness of patient health records; health summaries and consultation notes.	Physical conditions conducive to confidentiality and privacy; physical access to premises; available equipment for comprehensive care; Doctor's bag; safe and quality use of medicines policies; systems to ensure vaccine potency; systems to minimise the risk of health care associated infections.
Safety, Quality Improvement and Education	Practice Management
Clinical risk management systems; clinical governance; patient identification; clinical and administrative staff training.	Human resource system; occupational health and safety; confidentiality and privacy of health information and information security.
Rights and Needs of Patients
Systems and staff training to ensure culturally appropriate care; patient feedback; presence of a third party consent and procedure.

 

Quality Improvement

Most practices currently operate while observing the minimum standards even when these haven’t been documented. The first step to achieving quality improvement is to organise current systems into a structure that permits practice principals to set achievable goals for their practice. WentWest can assist your practice to take this first step. Email your query to: alex.mclaren@wentwest.com.au

Quality improvement is about using relevant patient and practice data to inform decisions regarding patient access, chronic disease management and preventative health care.  

If your practice team is confident about meeting the minimum standards, then it is time for a new challenge.

You can start by examining your practice structures, systems and clinical care. The next step would be based on evidence produced by the practice’s own data and, as the RACGP recommends, this data can be sourced from patient or staff feedback, a critical review of your clinical database and/or analysis of near misses and mistakes.

Reviewing your own practice data

Practices need to review their own patient population, age/sex profile, community profile, measure of disadvantage and chronic disease profiles and benchmarks. Effective information management techniques will allow practices to collect and analyse practice data and make decisions for service changes based on that data. Using information technology innovatively can assist practices in performing quality improvement activities to improve the health of their patient population.

Data coding is an essential part of this process. A practice should have a streamlined data coding system used consistently by staff working at the practice. For example, a patient newly diagnosed with diabetes would be coded under either ‘Type 1’ or ‘Type 2’ rather than having different codes, some of them based on spelling mistakes. We have found up to10 different codes for diabetes in a two-practitioner surgery due to locums, practice nurses and general staff turnover. A code system that lets practitioners know the protocol to be used for that particular practice will ensure data accuracy and better informed decision making.

Quality Improvement Tools and Links

The RACGP, in its website 'Oxygen: Intelligence in Practice' recommends the Pen CAT Tool as a way to improve using patient information to better inform decisions in both clinical and business settings. 

Pen CAT Tool

The PCS Clinical Audit System (CAT) is a clinical information system that supports quality improvement in information management and enhances the business capability of General Practice. The Pen CAT Tool is able to identify patient demographic and clinical cohorts to produce pie and bar charts according to the criteria selected. By clicking on a wedge or bar of the chart, a list of patient names can be immediately printed or exported as a PDF file or an Excel spreadsheet.

The Pen CAT Tool allows clinicians to analyse this data. It can highlight areas where improvements are needed (such as better recording of allergy or smoking status) or where data needs to be “cleansed” (such as where no date of birth or gender is recorded) as well as cross referencing diseases, medications and particular demographic groupings.

It also includes a medication count where patients on different types of medicines can be identified. It is easy to use, for example, to identify all patients over sixty on five or more medications. These patients can then be targeted, if appropriate, for a Home Medicines Review.

Practices located in the WentWest region, can apply for a copy of the Pen CAT Tool by either completing the following form: Pen CAT Tool Expression Of Interest or contacting: alex.mclaren@wentwest.com.au

Links and Resources

RACGP Oxygen

RACGP 4th Edition Standards

Pen CAT Tool website

How do I use CAT

Video Tutorials – Pen CAT Tool

Video Tutorial – Sidebar©

QPP – Medicare Local Context 

 

Latest News

Western Sydney Medicare Local progress update, click here to read