PIPQI Measures: National Report - a closer look at the smoking measure and how we can help your general practice

How can your individualised Practice Report provide insights to help you manage the patient smoking status for your practice?

In this article we are taking a closer look at Quality Improvement Measure (QIM) 2: Percentage of active patients with a smoking status recorded.

For patients aged 15 to 29, only those with smoking status recorded in the last 12 months of data extraction are counted towards this PIPQI measure. For patients aged 30 or older, the latest smoking status is considered as current status.

Why is this important?

According to the latest data from the Australian Institute of Health and Welfare:

Tobacco smoking is the leading cause of preventable diseases and death in Australia.
Smoking was responsible for 9.3 per cent of the total burden of disease in Australia in 2015, making it the leading risk factor contributing to disease burden.
Almost three-quarters (73 per cent) of the burden due to smoking resulted in premature death.
In 2015, smoking was responsible for more than 1 in every 8 deaths.
Approximately 12 per cent of Australian adults continue to smoke.

Which populations should interventions target?

Men are more likely than women to smoke, as are Indigenous people (40 per cent).
People living in the lowest socioeconomic areas.
People living in outer regional or more remote areas.
People who are unable to work or are unemployed.
People with lower education levels.

Recording of smoking status keeps our records up-to-date and prompts us to have conversations about smoking with appropriate patient populations. There is good evidence that brief advice significantly increases cessation rates and is highly cost effective.

How good are we at recording this now?

In the inaugural PIPQI Measures: National Report released by AIHW in August 2021, the data collected in the EMPHN catchment, 68.0 per cent of patients had a current smoking status recorded. If the ideal rate is 100 per cent, how do you feel about this result?

Shortly, you will be able to look at your own updated individualised Practice Report. How does your practice compare to the EMPHN average, and the Australian average? How do you feel about your result? Is it higher or lower than you expected? What are the factors unique to your practice and your patients that you think influences the result?

Is 100 per cent ever achievable? For example, for younger patients (15 to 29 years of age) the status needs to be updated annually. How achievable is that? What is a good target in which to aim? For example, should you have a target of 80 or 90 per cent? Think about what is achievable at your practice.

Set a Goal

Using a plan, do, study, act (PDSA) cycle and associated documentation (see emphn.org.au/polar for details), let’s start with Plan.

Plan

Plan how you are going to improve your smoking recorded rates. An important step in making changes is to have an overall goal or desired result to work towards, with a definable measure.

Goal

For example: for your desired result you may aim to improve the proportion of active patients with smoking status recorded from 60 per cent to 70 per cent.

Measure

For example: we will measure the percentage of active patients with smoking status recorded at baseline (day 0), and for the next 6 months (day 180) after making continuous changes.

Tips for improving the recording of smoking status in your practice

Around the practice

Check the POLAR Quality page in the Clinic Summary Report (polarexplorer.org.au) for your practice’s latest smoking status compared to the RACGP Accreditation minimum standard of 75 per cent
Check the POLAR PIPQI Clinic Report (polarexplorer.org.au) for your practice’s latest PIPQI smoking status (QIM 2)
Install and access the new Walrus (polarexplorer.org.au)This helps by highlighting which individual patients do not have their smoking status recorded.
Include recording of smoking status on your practice’s new patient registration form.
Conduct targeted monthly or six-week campaigns in your practice to increase recording of smoking status. For example: print a card for reception to hand out to patients that says “This month we are updating everyone’s smoking status. You will be asked in your consultation if your smoking status is recorded correctly. Your doctor has specialist training in discussing smoking and will be happy to discuss smoking with you if you wish.”

As a team

Consider a team meeting and education session using POLAR and Walrus information (polarexplorer.org.au).
Discuss correct recording (‘coding’) of smoking information with clinical staff members under individual patient records in their clinical information system (CIS).
Brainstorm ideas in your team to help improve smoking recording. You might form a project team.

Do it, study it, and act on any changes you want to make

Its time to action the plan, – test the ideas, then routinely study and reflect on what happened, and make any changes needed as a continuous improvement cycle.

For example, A practice undertook a short-campaign (6 weeks) on recording patient smoking status. The practice team discovered they had to use a workaround to refresh the recording of smoking status in the clinical information system. So, in their reflection session, they updated the practice team’s understanding of how to correctly record smoking status. This team approach saw the patient smoking status recorded metric improve overtime.

EMPHN Support

The future of Australian primary healthcare landscape is changing through the introduction of the 10 building blocks of high performing care, the RACGP Standards for general practices 5th edition and the Practice Incentive Program Quality Improvement (PIPQI) initiative.

EMPHN is continuing to provide regular, individualised Practice Reports supported by our quality improvement information (see emphn.org.au/qi) for any general practice in the region wanting to use data to drive improvement.

These Practice Reports include information on the 10 quality improvement measures (QIMs) for the Practice Incentives Program Quality Improvement (PIPQI) initiative. The Practice Reports will be updated to include QIM averages for the EMPHN catchment, and across Australia. Individualised Practice Reports to now include PIPQI comparisons

Remember: you can choose any area of data driven quality improvement for the PIPQI initiative, as long as you are working in partnership with EMPHN. However, the 10 measures QIMs have been chosen as evidence-based measurements and are the ideal starting point for a quality improvement activity.

More information

More information on our quality improvement program and information is available on our website (emphn.org.au/qi and emphn.org.au/polar).

Details on your PIPQI measures is available in POLAR (polarexplorer.org.au)

The RACGP has published a guide to supporting smoking cessation for health professionals.

If you have any questions about quality improvement, please contact us on 03 9046 0300 or email practicesupport@emphn.org.au

HealthPathways Melbourne

Visit the Smoking Cessation Advice page on Health Pathways Melbourne for assistance on how assess and manage smoking within your practice.

Are you a GP or health professional in our region who doesn’t have access to HealthPathways Melbourne? Request access online (https://melbourne.healthpathways.org.au/LoginFiles/Logon.aspx?autologon=0) or contact info@healthpathwaysmelbourne.org.au

This article was written with the kind contribution from Dr Jeannie Knapp, GP Adviser at North Western Melbourne Primary Health Network (NWMPHN).