Patient Impact: Quality Improvement Measures

Our Quality Improvement metrics empower you to review key areas within your practice that may require improvement, offering clear, actionable insights to help you meet your goals.

To navigate these metrics, go to Clinic Optimisation tab > Quality Improvement > Patient Impact.

The sections included in this article are:

• 1. Goal: Use this overview to understand if your goal is achievable
• 2. Measure: Are you on track to reach your goals?
• 3. Action: Click below to view your patient list and begin actioning your goal
• 4. Quality Improvement Measures
  • Bp and MD customers
    • QIM: 75+ Health Assessment
    • QIM: Item 715
    • QIM: Proportion of Patients with Ethnicity Recorded
  • Bp only
    
    • QIM 02: Proportion of Patients with a Smoking Status Recorded

• • • QIM 04: Proportion of Patients Aged 65 and Over Immunised Against Influenza

• • • QIM 05: Proportion of Patients with Diabetes Immunised Against Influenza

• • • QIM 06: Proportion of Patients with COPD Immunised Against Influenza

• • • QIM 07: Proportion of Patients with an Alcohol Consumption Status Recorded

• • • QIM 10: Proportion of Patients with Diabetes with a Blood Pressure Result

• • • QIM: Proportion of Aboriginal and Torres Strait Islander Patients Registered for CTG

NEW: Quality Improvement metrics in Cubiko!

We’re excited to share that we have expanded the Quality Improvement cabinet in Cubiko, adding four new QI activities to help your practice strengthen preventive care, improve data quality and support PIP QI reporting.

The NEW activities include:

• QIM 01: Patients with diabetes and a current HbA1c result

• QIM 03: Patients with a weight classification

• QIM 08: Patients with risk factors recorded for CVD assessment

• QIM 09: Female patients with an up-to-date cervical screening

These new metrics make it easier for your team to identify gaps, improve patient care, and demonstrate progress towards your quality improvement goals.

 

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1. Goal

This step helps you assess whether your practice goals are achievable by offering insights into patient eligibility across various categories. By reviewing the number of patients eligible and actionable for each measure, you can identify where improvements are needed.

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2. Measure

Use the percentages and trend graphs provided for each measure to track your progress and ensure you are on track to meet your targets. This can be measured against the practice goal, which can be amended in the Settings area of Cubiko. This data can be used to help study the progress of your Quality Improvement activity and recorded in your Plan Do Study Act (PDSA) cycle.

Using the trend graph, we are able to forecast ahead as well as look back historically. Using our example trading graph above if looking ahead using the date range, the forecasted percentage of patients with influenza vaccine references the patients who are estimated to still have a current vaccine.

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3. Action

For each measure, you can view your patient list and begin actioning steps to improve patient outcomes. 

The patient list provides you with the opportunity to select patients who have an appointment coming up, to be able to opportunistically provide the service to those patients indicated on this list if clinically indicated - this may be the first step you take to introduce this QI measure to your team.

You will also see patients here with "no booking" and can use this list to proactively reach out to your patients and book them for the service.  

Using Key Filters on the Pages:

Use the filters on the left-hand side to:

1. 1. Adjust your dates and PIP quarter.
      

1. 1. Filter via practitioners and appointment types
      

Use the filters on the table to:

1. 1. Use the toggle to Include "RACGP Active" patients (patients who have 3+ attended, billed, or completed appointments in the last 2 years, who are not marked inactive or deceased).
      
   2. Use the 'Patients with...' drop-down on the right-hand side of the table. Select the option to review this list daily or view it ahead of time to proactively book patients.
      

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4. Quality Improvement Measures

The numbered Quality Improvement Measures (e.g., QIM 02) are aligned with the Department of Health and Aged Care's Practice Incentive Program (PIP) 10 Quality Improvement Measures. You can view the full technical specifications here.

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QIM: 75+ Health Assessment

This figure represents the percentage of patients aged 75+ who received a health assessment in the last quarter, out of the total number of patients who were potentially eligible for this service.

For a complete list of these patients, go to the QI cabinet: click here.

Eligibility is based on previous billings of health assessment items, which include both VR and non-VR item numbers. Potential billing revenue is based on item 703 and will not take into account any gap fees charged. See the MBS for more details.

These metrics are calculated based on the number of RACGP active patients at your Practice location, who are over the age of 75 and are included in the item eligibility lists for 75 + health assessments.

Always provide these lists to Practitioners to make billing decisions. Please see our knowledge base article for more information about how to use these metrics, or download a copy of our PDSA template here.

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QIM: Item 715

These metrics compare your Practice goal for providing services to patients who could be eligible for an item 715 (or equivalent). These metrics summarise your progress, identify areas for improvement and help track changes over time.

For a complete list of these patients, go to the QI cabinet: click here.

Eligibility for item 715 is based on patient demographics and historical billings at the Practice of items 715, 92004 (Video Telehealth) and 92016 (Telephone) and also prescribed medical practitioner items 228, 92011 (Video Telehealth) and 92023 (Telephone).

To see more on how to set QI goals, click here.

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QIM: Proportion of Patients with Ethnicity Recorded

This figure shows the proportion of RACGP active patients who have their ethnicity information recorded. 

Selected Cubiko metrics to help identify any issues with the recording of patient ethnicity, highlight potential improvements, and track progress through a PDSA cycle.

As per the RACGP standards for General Practice (5th Ed, p99), to meet the standard of criterion QI2.1 Health Summaries, a practice must have a current health summary for at least 75% of your active patient health records; this health summary should include ethnicity and cultural background. These metrics are calculated based on the number of RACGP active patients at your Practice location.

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NEW! QIM 01: Proportion of patients with diabetes with a current HbA1c result

Regular HbA1c testing is essential for managing diabetes and preventing complications.

This QI activity shows the proportion of active patients with Type 1 or 2 diabetes who have a recorded HbA1c result in the past 12 months, and highlights those who may be overdue.

This QI activity provides the number of eligible patients, how many are attending today, an overview of progress towards practice goals, and a downloadable patient list to support follow-up.

These metrics are based on specifications from the Department of Health and Aged Care Quality Improvement Measure #1.

Active patients will be shown in this calculation if they have Type 1 or Type 2 diabetes listed as an active diagnosis in their patient record. Patients are excluded from the calculation if they;

• - had secondary diabetes, gestational diabetes mellitus (GDM), previous GDM, impaired fasting glucose, impaired glucose tolerance.
• - had results from measurements conducted outside of the service which were not available to the service and had not visited the service in the previous 12 months.

Please note that this metric uses the standard 12 month measurement period, however blood glucose control may require alternative periods of intervention which is determined by the treating Practitioner.

Cubiko are not including all pathology results in this calculation, which results are relevant are for the Practitioner to determine and are located in the patient clinical record in your PMS.

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QIM 02: Proportion of Patients with a Smoking Status Recorded

This figure represents the percentage of RACGP active patients with a smoking status recorded. These metrics are based on specifications from the Department of Health and Aged Care Quality Improvement Measure #2.

In line with these specifications, a patient aged 15 years and over is counted as having their smoking status recorded if:

• The patient is 15 to 29 years old and their status has been recorded in the last 12 months, or
• The patient is aged 30 years or older and their status has been recorded at least once since turning 30

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NEW! QIM 03: Proportion of Patients with a weight classification

Weight status is a key health indicator, with underweight, overweight and obesity linked to increased morbidity and chronic conditions. Weight status is an important indicator for monitoring health risks like diabetes, cardiovascular disease and cancer.

Practices can use this activity to identify eligible patients, track visits, monitor progress towards practice goals, and download patient lists to improve data quality and patient outcomes.

This figure represents the percentage of regular RACGP active patients with a BMI recorded in the past 12 months. Along with the percentage of people who will fall out of the metric in the next 3 months.

These metrics are based on specifications from the Department of Health and Aged Care Quality Improvement Measure #3.

In line with these specifications, a patient is counted as having their weight classification status recorded if:

• The patient is aged 15 years or over
• The patient has had their weight recorded or updated within the last 12 months

 

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QIM 04: Proportion of Patients Aged 65 and Over Immunised Against Influenza

This figure represents the percentage of RACGP active patients over 65 that have had a fluvax in the last 15 months.

These metrics are based on specifications from the Department of Health and Aged Care Quality Improvement Measure #4.

There are some clinical specifications that cannot be met. Cubiko is unable to exclude patients from the below measurement if they:

• Did not receive the vaccination due to medical or system reasons, or because they refused it.
• Had measurements outside of your practice that were not recorded in their patient record and have not visited your practice in the last 12 months.

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QIM 05: Proportion of Patients with Diabetes Immunised Against Influenza

This figure represents the percentage of RACGP active patients with diabetes that have had a fluvax in the last 15 months.

These metrics are based on specifications from the Department of Health and Aged Care Quality Improvement Measure #5.

There are some clinical specifications that cannot be met. Cubiko is unable to exclude patients from the below measurement if they:

• Did not receive the vaccination due to medical or system reasons, or because they refused it.
• Had measurements outside of your practice that were not recorded in their patient record and have not visited your practice in the last 12 months.

Patients who have had gestational diabetes but also have Type 2 diabetes will be included.

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QIM 06: Proportion of Patients with COPD Immunised Against Influenza

This figure represents the percentage of RACGP active patients who have a COPD status and have had a fluvax in the last 15 months, and more than 3 visits in the last 2 years. 

These metrics are based on specifications from the Department of Health and Aged Care Quality Improvement Measure #6.

There are some clinical specifications that cannot be met. Cubiko is unable to exclude patients from the below measurement if they:

• Did not receive the vaccination due to medical or system reasons, or because they refused it.
• Had measurements outside of your practice that were not recorded in their patient record and have not visited your practice in the last 12 months.

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QIM 07: Proportion of Patients with an Alcohol Consumption Status Recorded

This figure represents the percentage of RACGP active patients with an Alcohol consumption status recorded. 

These metrics are based on specifications from the Department of Health and Aged Care Quality Improvement Measure #7.

In line with these specifications, a patient aged 15 years and over is counted as having their alcohol status recorded if the status has ever been recorded.

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NEW! QIM 08: Proportion of patients eligible for a CVD assessment

Accurate cardiovascular disease (CVD) risk assessment depends on up-to-date clinical data.

This QI activity shows the proportion of eligible patients with the necessary risk factors recorded, including smoking status, blood pressure, cholesterol, glucose and demographics.

Practices can use this QI activity to quickly identify gaps in recording, track improvements, and download patient lists to close gaps and strengthen preventive care.

This figure represents the percentage of RACGP active patients who fulfil the necessary clinical conditions to enable a CVD assessment.

These metrics are based on specifications from the Department of Health and Aged Care Quality Improvement Measure #8.

Active patients will be shown in this calculation if they do not have a coded diagnosis of CVD and may be eligible for a CVD assessment.

To be considered as possibly eligible for a CVD assessment, Cubiko identifies if a clinical risk factor has been recorded or not recorded, these include whether the patient has;

• A current (within the last 12 months) tobacco smoking recording.
• A current (within the last 2 years) systolic blood pressure recording.
• A current (within the last 2 years) total cholesterol and HDL recording.
• A current (within the last 2 years) fasting glucose or HbA1c test result or a diabetes diagnosis.
• Has their age and sex recorded.

Patients on these lists are aged between 45-74 years if they do not identify as Indigenous and 35-74 if they do identify as Aboriginal and/or Torres Strait Islander. 

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QIM 10: Proportion of Patients with Diabetes with a Blood Pressure Result

This figure represents the percentage of RACGP active patients with a blood pressure result in the past 6 months.

Patients who have had gestational diabetes but also have Type 2 diabetes will be included.

These metrics are based on specifications from the Department of Health and Aged Care Quality Improvement Measure #10.

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QIM: Proportion of Aboriginal and Torres Strait Islander Patients Registered for CTG

This figure shows the proportion of Aboriginal and Torres Strait Islander RACGP active patients who are registered for CTG at your Practice (as identified by the field in your PMS patient demographics).

Selected Cubiko metrics to help identify any issue with the Close the Gap (CTG) registration of Aboriginal and Torres Strait Islander patients, highlight potential improvements, and track progress through a Plan, Do, Study, Act (PDSA) cycle. Cubiko uses your PMS's ethnicity data to determine a patient's potential eligibility for this service. 

Please see our knowledge base for more information about how to use these metrics, or download a copy of our PDSA template here.

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Enhance Practice Quality Improvement with CPD Activities

Incorporate CPD into your practice's Quality Improvement efforts. Discover our "My CPD Outcomes" activities, designed to enhance Quality Improvement initiatives while earning CPD points for practitioners. Find out more here!

Example: Unlock Better Patient Outcomes with 75+ Health Assessments!

Identify patients over the age of 75 who may be eligible for a health assessment using Cubiko’s actionable patient lists. This is a whole practice team effort to align goals and improve patient care. Steps to get started:

1. Practice Collaboration - Quality Improvement Activity Use the Quality Improvement Cabinet (QIM: 75+ Health Assessment) to set and track your practice goals. Access patient lists and manage your progress here.

2. Earn CPD Hours - MyCPD outcomes Practitioners can earn up to 10 CPD hours by completing the Cubiko Data Analysis for patients aged 75+ who are eligible for a health assessment in the new My CPD Outcomes cabinet.

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