Healthy Futures Aboriginal Community Controlled Services Report Card (AIHW)
NACCHO’s plan is to develop a series of Report Cards to Members using data consented to by Member Services to summarise the achievements, continuous quality improvement and outcomes being delivered by the ACCHO Sector as well as identifying areas of concern and gaps in service accessibility where additional resources and money are required. The Report Cards will also be used to relay information in a readily understandable form to policy and decision makers. “The Healthy Futures Aboriginal Community Controlled Health Services Report Card” is the first. NACCHO commissioned the Australian Institute of Health and Welfare (AIHW) so that NACCHO could work with this authoritative agency to learn, as well as help develop an incontestable document. Collaboration in the development of the Report Card is helping develop capacity for data analysis within NACCHO and through NACCHO to its Member Services.
The information was based primarily on the Online Services Report (OSR) collection for 2012- 2013, and the National Key Performance Indicators (nKPIs) covering the period December 2012 to December 2013. Indicator-related information is collected on chronic disease prevention and management, and maternal and child health. The nKPIs aim to help inform improvements in the delivery of primary health care services by supporting continuous quality improvement activity among and between service providers. In 2012-2013, 141 ACCHOs participated in OSR data collection processes.
During 2013-14, these ACCHOs:
- provided services to over 316,000 clients, about 252,000 of whom were Indigenous;
- provided over 2.4 million episodes of care nationally, with around 2.1 million of these being for Indigenous Australians. An episode of care is a visit to the Health Services, and may include contacts with multiple health workers; and
- made 3.7 million client contacts, including contacts with health staff and drivers who facilitate access to primary care, and referrals to other health services where ACCHS provided transport services.
124 ACCHOs provided valid data on the number of Indigenous regular clients in December 2012, June 2013 and December 2013. At these ACCHOs, the number of clients increased by 6% over the period from 183,435 in December 2012 to 194,521 in December 2013. The nKPIs include 16 indicators that measure ‘process of care’ performed for clients (such as tests, procedures or Medicare-claimable services), and 5 outcome measures.
ACCHOs showed improvement for 2 of the 5 outcome indicators:
- the proportion of clients with BMI recorded who were not overweight or obese; and
- the proportion of clients with type 2 diabetes whose HbA1c result was less than or equal to 7%.
The proportion remained stable for the remaining three outcome indicators – babies with normal birthweights, clients who have never smoked, and clients with type 2 diabetes with blood pressure less than or equal to 130/80mmHg.
Health outcomes are influenced by the work of primary health care; however, a range of other factors are major influencers such as education, employment, income and housing.
The Report Card notes that: ACCHOs have done particularly well in increasing the proportion of Indigenous regular clients with the following processes of care:
- who receive their first antenatal visits prior to 13 weeks of pregnancy;
- with birth-weight recorded;
- who are 0-4 who have had an MBS health assessment (item 715);
- who are 25 and over who had an MBS health assessment (item 715);
- with type 2 diabetes who are immunised against influenza;
- with COPD who are immunised against influenza;
- with type 2 diabetes who received an MBS general practice management plan;
- with type 2 diabetes who received an MBS team care arrangements;
- with smoking status recorded; and
- with alcohol consumption recorded.
ACCHOs have done particularly well in increasing the proportion of Indigenous regular clients with the following outcomes:
- with type 2 diabetes who had an HbA1c result ≤7%with Body Mass Index (BMI) recorded who were not overweight or obese.
Continuous Quality Improvements: More is needed in the following areas to increase the proportion of Indigenous regular clients for the following process of care indicators, namely those patients with type 2 diabetes who receive some tests, including:
- Kidney function tests
- HbA1c tests
- Blood pressure test
- eligibility for cervical screening
- those aged 50 and over who are immunised against influenza
- Cardiovascular Disease (CVD) who had a kidney function test.