Volume 197 - Issue 6
The use of key performance indicators to benchmark individual clinic performance in managing a complex chronic infectious disease
Authors: Mark D Kelly, Jennifer K Broom and Sharon Young
Med J Aust 2012; 197 (6): 330-331. || doi: 10.5694/mja12.10126
Published online: 17 September 2012
Published online: 17 September 2012
To the Editor: The focus of HIV clinical care has shifted since the advent of potent antiretroviral therapy (ART). This change is characterised
by a reduction in HIV-specific morbidities, an increase in HIV
non-specific comorbidities,1,2 and
an accompanying lack of clinician confidence in managing these comorbidities.3 The measurement of key performance indicators (KPIs) is useful for monitoring and improving clinical performance, but it is yet ...
To the Editor: The focus of HIV clinical care has shifted since the advent of potent antiretroviral therapy (ART). This change is characterised by a reduction in HIV-specific morbidities, an increase in HIV non-specific comorbidities,1,2 and an accompanying lack of clinician confidence in managing these comorbidities.3 The measurement of key performance indicators (KPIs) is useful for monitoring and improving clinical performance, but it is yet to be widely adopted in HIV clinics in Australia.4
As part of this pilot study, KPIs were developed by clinicians involved in HIV clinical care across Queensland. Clinic performance was measured in ART-related and non-ART-related care domains (Box). A clinic achieved a given KPI for a patient if the result was documented in the clinical file, regardless of whether the investigation was performed by the HIV clinic or another care provider.
The objective of this study was to permit individual clinics to measure their performance and compare it with that of their peers, and to adopt systems to improve care delivery in areas of suboptimal performance. Four publicly funded clinics participated, and data were collected for the 2010 calendar year. In total, 963 patients with HIV attended these clinics in 2010, which equates to 44% of the estimated number of patients with HIV in Queensland.5 In general, performance was of a high standard in ART-related care domains (Box, KPI 1–2). The state total results ranged from 92% to 97%, and individual clinic results ranged from 80% to 100% (Box). In contrast, performance was less comprehensive in non-ART-related care domains (Box, KPI 3–6). The state total results varied from 54% to 86%, and those of individual clinics varied from 36.9% to 98.2%.
The measurement of KPIs is likely to improve clinical outcomes in areas of rapidly evolving practice such as HIV medicine. With a movement towards outcome assessment and activity-based funding in health care in Australia, it is essential to develop clinically relevant performance measures that can be applied in a variety of clinical settings.
Proportion of patients for whom KPIs were met by four HIV clinics in Queensland in 2010
Competing interests
No relevant disclosures.
References
- Palella FJ Jr, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immuno-deficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998; 338: 853-860. 0_BABJGJJJ
- Palella FJ Jr, Baker RK, Moorman AC, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr 2006; 43: 27-34. 0_i1142993
- Forrester J. Queensland HIV models of care 2008. http://www.health.qld.gov.au/sexhealth/documents/qhivmodcare08.pdf (accessed Jan 2012).
- Harris M, Kidd M, Snowdon T. New models of primary and community care to meet the challenges of chronic disease prevention and management: a discussion paper for NHHRC. http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/16F7A93D8F578DB4CA2 574D7001830E9/$File/New%20Models%20 of%20Primary%20and%20Community%20Care%20Final%20(M%20Harris%20M%20Kidd%20T%20Snowden).pdf (accessed Aug 2012).
- Queensland Health. 2010 HIV/AIDS report: epidemiology and surveillance. www.health.qld. gov.au/sexhealth/documents/hivaidsannual report.pdf (accessed Jan 2012).