Using routinely-collected, linked data to measure and monitor health system performance in Australia: development of an indicator of continuity of primary health care

Objective To examine a potential new Australian health system indicator—continuity of care (CoC) in general practice—derived from whole-of-population linked administrative data.

Using data from Census 2016 and 2021 and the Medicare Benefits Schedule, available via the Person-Level Integrated Data Asset (PLIDA), we examined an indicator of CoC in general practice, the Usual Provider Index (UPI), over eight overlapping 2-year periods (2016-17 to 2022-23), and the 2-year period following the introduction of universal telehealth in April 2020). We measured population coverage of the UPI, sociodemographic- and health-related variation in high COC (UPI≥0.7), and changes in CoC over time.

Population coverage of the UPI was high (>75%); higher for groups with greater healthcare needs, including older people and people with chronic conditions. Coverage decreased with increasing remoteness. In 2022-23, 36% of those with a UPI score had high CoC; proportions with high CoC were greater for older people, those born overseas, not proficient in English, and with health conditions, but lower for people living in more remote areas. Prior to 2020, 32-33% of the population had high CoC, increasing to 39% in the 2-year period directly following the introduction of universal telehealth.

When derived from whole-of population linked administrative data, the UPI is a suitable indicator of CoC for people with varying healthcare needs, and across different settings. Using new national data assets, the UPI could be included in routine health system reporting as one indicator of quality of care. What is known?Health system performance monitoring aims to facilitate health system planning and improvement. Whole-of-population linked administrative data may be used to extend current health system indicators in Australia. What this paper adds?We examined a potential new indicator—continuity of care within general practice—by assessing coverage and sensitivity to differences between groups and over time. Coverage was high, those with greater healthcare need had higher continuity, and continuity increased after the introduction of telehealth. What are the implications?New national data assets can be used to derive health system indicators, enhancing insight into Australian healthcare. Competing Interest Statement The authors have declared no competing interest. Funding Statement This project was funded by the Australian Institute of Health and Welfare and the Australian Government's Medical Research Future Fund (grant number 2006309). Emily Banks receives support from the National Health and Medical Research Council (grant number 1136128). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Australian National University Human Research Ethics Committee of the Australian National University gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Ethics approval Ethics approval for this study was granted by the Australian National University Human Research Ethics Committee (HREC 2021/619). Data availability Data from the Person-Level Integrated data asset are available for approved projects to approved government and non-government users. Person Level Integrated Data Asset (PLIDA) | Australian Bureau of Statistics (abs.gov.au) Conflicts of interest The authors declare that they have no competing interests. Declaration of funding Declaration of funding This project was funded by the Australian Institute of Health and Welfare and the Australian Government’s Medical Research Future Fund (grant number 2006309). Emily Banks receives support from the National Health and Medical Research Council (grant number 1136128). Data Availability Data from the Person-Level Integrated data asset are available for approved projects to approved government and non-government users.