North East Valley Division of General Practice 23rd April 2008Overview of the Practice Health Atlas1...

North East Valley Division of General Practice

Overview of the Practice Health Atlas 123rd April 2008

The Practice Health Atlas

Setting Up Good Directions

Graeme Berry

Wednesday 23rd April ,2008



• The PHA is a resource for informed decision making, both clinical and financial.

• It provides disease profiles.• Matches your practice billing details

with EPC items.

What is it?



Creating PHAs for practices (at no cost)– facilitating discussion of the results– assist in what actions can be taken– aggregating the data from different

practices (compare with other practices and national benchmarks)

What is the division doing?



• A quality database.• A comprehensive team-based care

program.• A pro-active approach to patient care.• A ‘best practice’ clinical care program.

What can be the outcomes of follow up actions?



• A cost effective business model.• An efficient practice accreditation

program.• A personal and practice focussed

professional development program.• A evidence based marketing of the

practice services.

What can be the outcomes of follow up actions?


Overview of the Practice Health Atlas 623rd April 2008Wednesday 23rd April, 2008 Overview of the Practice Health Atlas

Number patients

Your total population: 6990

Your total cleansed population 6729

15-month patient population*:(3/28/2007)

4631

Aboriginal or Torres Strait Islanders: 5

Pensioners: 1445

DVA patients: 93

Patients on 5 or more current medications: 930

30-month patient population: 5600

* Excludes patients with no postcodes or with post boxes, and those where date of birth was not recorded. It is referred to as your ‘patient population’ in this report, and is the cohort upon which the majority of the Practice Health AtlasTM analysis is based.

Patient Population Overview - characteristics of your patient population



Example of patient population profile mapped by postcode.



Practice Health Atlas (PHA) Epidemiology

Chart 1. Patient population profile: Top 10 postcodes by percentage

Table 1. No. of patients seen versus no. of total persons in the top 10 postcodes

Patient population postcode profile Market share of the patient

population

0%

5%

10%

15%

20%

25%

30%

3088 3095 3089 3754 3090 3085 3094 3099 3091 3087

Postcode

Per

cent pat

ient popula

tion

The patient population seen in last 15 months is distributed over 267 postcodes. Chart 1 shows the top 10, in which 81.78% of these patients live.

PostcodeNo. patients

seen

Percent of patient

population

Total no. people* living in postal area

Percent of total no. people

3088 3664 26.2% 26,155 14.0%3095 2740 19.6% 28,652 9.6%3089 2341 16.8% 10,286 22.8%3754 634 4.5% 4,280 14.8%3090 535 3.8% 2,157 24.8%3085 416 3.0% 12,347 3.4%3094 356 2.5% 8,178 4.4%3099 283 2.0% 4,736 6.0%3091 249 1.8% 1,497 16.6%3087 211 1.5% 8,739 2.4%Total 11,429 107,027 10.7%

* Source: Australian Bureau of Statistics (ABS). 2006 Census Data Basic Community Profile. Canberra: ABS

No. of patients seen as percent of patient population compared with total persons in the top 10 postcodes



Age/Sex profile

Profile Graphs and related Charts

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Age group

Per

cent

Females Males Sex not recorded

Number %

Males: 5989 42.85

Females: 7440 53.23

Sex not recorded: 547 3.92

Total: 13976 100.00



Case Study 1 – No. of patients attending

Total Number of Patient Records 12, 412 100%

Patients attending in last 30 months 9,748 79%

Patients attending in last 15 months 8,276 67%

What actions would you recommend to the PMs, PNs and GPs?

What are the outcomes of the appropriate actions?



Case Study 2 – No. of patients with diabetes

What actions would you recommend to the GPs and nurses?


Number of identified diabetics 181 1.9%

Expected no. of diabetics 487 5.8%

Conclusion: the number of diabetics is either under-recorded and/or under diagnosed.



Example Diabetes Profile by postcode.

Profiles provided for eight chronic diseases.



Prevalence of diabetes profile by age group

0

10

20

30

40

50

60

70

Age Group

Perc

ent Patient Popula

tion

Diabetes profile National Diabetes Benchmark (age specific rate)*




0.0

10.0

20.0

30.0

40.0

50.0

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 4445 - 4950 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 - 79

80 - 84

85 - 89

90+





Age GroupNumber of diabetes patients

Percent diabetes patients

(per age group)

Total patient population

(per age group)

Rate in total patient population (age specific rate)

National Diabetes Benchmark (age

specific rate)*

0 - 4 1 0.3 973 0.1 0.15 - 9 4 1.0 887 0.5 0.110- 14 2 0.5 989 0.2 0.115 - 19 5 1.3 1178 0.4 0.420 - 24 6 1.5 1008 0.6 0.425 - 29 4 1.0 845 0.5 0.630 - 34 7 1.8 836 0.8 0.635 - 39 9 2.3 1092 0.8 1.940 - 44 16 4.0 1246 1.3 1.945 - 49 23 5.8 1332 1.7 3.950 - 54 41 10.4 1006 4.1 3.955 - 59 48 12.1 802 6.0 8.160 - 64 48 12.1 525 9.1 8.165 - 69 48 12.1 363 13.2 13.970 - 74 34 8.6 248 13.7 13.975 - 79 45 11.4 231 19.5 13.380 - 84 30 7.6 190 15.8 13.385 - 89 21 5.3 116 18.1 13.390+ 4 1.0 109 3.7 13.3Total 396 100.0 13,976* ABS (2006) 4364.0 National Health Survey: summary of results 2004-2005. Canberra: ABS

Prevalence of diabetes by age group

0.0

10.0

20.0

30.0

40.0

50.0

0 - 4

5 - 9

10 - 14

15 - 19

20 - 24

25 - 29

30 - 34

35 - 39

40 - 4445 - 4950 - 54

55 - 59

60 - 64

65 - 69

70 - 74

75 - 79

80 - 84

85 - 89

90+




Case Study 3 – No. of patients on 5 or more medications

What actions would you recommend to the GPs and nurses?


Number of patients on 5 or more medications 956

No. of HMRs 2



Case Study 4 – Comparative demographic and clinical data

PracticeNum

records30

mth %15

mth %%

diabetics%

asthma% mental

health%

cvd

% bone

disease

% 5 or more meds

% 5+ meds

w HMR

Practice A 12058 51.5% 45.4% 2.4% 9.9% 9.0% 1.4% 2.7% 7.9% 2.5%

Practice B 22148 53.5% 45.1% 3.8% 10.6% 7.9% 3.0% 3.9% 13.4% 1.6%

Practice C 8901 50.2% 39.7% 5.6% 11.4% 17.5% 3.9% 4.2% 17.7% 0.0%

Practice D 2504 94.9% 86.1% 18.0% 6.8% 32.2% 5.3% 25.1% 41.5% 40.0%

Practice E 26562 32.6% 25.0% 2.7% 6.1% 7.9% 2.8% 3.7% 14.3% 1.8%

Practice F 10839 50.3% 40.1% 2.4% 7.9% 7.4% 2.7% 2.7% 17.5% 2.8%

Practice G 32314 22.6% 18.6% 2.7% 9.1% 9.7% 1.7% 3.3% 15.8% 11.7%

Practice H 14666 33.6% 26.7% 7.2% 5.4% 12.3% 8.2% 7.2% 30.4% 10.4%

Practice I 6882 81.6% 67.6% 3.9% 11.3% 12.8% 4.7% 6.4% 17.4% 0.7%

Practice J 9165 78.2% 64.7% 5.0% 9.4% 9.1% 6.2% 6.4% 26.7% 0.8%

Practice K 11841 53.5% 39.6% 4.2% 10.1% 13.3% 9.0% 4.7% 18.1% 2.9%

Average 54.8% 45.3% 5.3% 8.9% 12.7% 4.4% 6.4% 20.1% 6.9%



• A total of 16 practices have already participated in the PHA.

• One of these practices has requested a second PHA.– It is their intention to use some of the statistics

and mapping contained in the PHA to demonstrate the need for funding of specialised services.

• PHA now uses 2006 ABS data.• Other endorsements to follow…

In Conclusion

North East Valley Division of General Practice 23rd April 2008Overview of the Practice Health Atlas1...

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