Should the healthcare compass in Australia point towards value-based primary healthcare?Jodie Oliver-Baxter A D , Lynsey Brown A and Paresh Dawda B C
A Primary Health Care Research & Information Service, Discipline of General Practice, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. Email: email@example.com
B Australian Primary Health Care Research Institute, School of Population Health, College of Medicine, Biology and the Environment, Building 63, Corner Mills and Egglestone Roads, The Australian National University, Canberra, ACT 0200, Australia. Email: Paresh.Dawda@anu.edu.au
C University of Canberra, Faculty of Health, University Drive, Bruce, ACT 2617, Australia.
D Corresponding author. Email: firstname.lastname@example.org
Australian Health Review 41(1) 98-103 https://doi.org/10.1071/AH15104
Submitted: 9 June 2015 Accepted: 1 February 2016 Published: 23 May 2016
This paper provides an overview of quality improvement in healthcare in an Australian context. Specifically, the paper considers issues around defining, quantifying, recording and incentivising quality improvement and accountability in primary healthcare. The role of newly emerging Primary Health Networks provides a context for the discussion. The paper draws on international learnings that provide a framework for examining the important elements of quality improvement among reforming primary healthcare organisations in order to support healthcare providers and offer an evidence base for policy makers and peak bodies moving forward.
References Australian Government. Primary Health Networks grant programme guidelines. 2015. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Program_Guidelines [verified 16 March 2015].
 Batalden PB, Davidoff F. What is ‘quality improvement’ and how can it transform healthcare? Qual Saf Health Care 2007; 16 2–3.
| What is ‘quality improvement’ and how can it transform healthcare?CrossRef | 17301192PubMed |
 Donabedian A. The quality of care. How can it be assessed? JAMA 1988; 260 1743–8.
| The quality of care. How can it be assessed?CrossRef | 1:STN:280:DyaL1czhslajsA%3D%3D&md5=4cc3df668523d006024cb4876864acbaCAS | 3045356PubMed |
 Oliver-Baxter J, Brown L, Bywood P. Integrated care: what policies support and influence integration in health care in Australia? Adelaide: Primary Health Care Research & Information Service; 2013.
 Australian Commission on Safety and Quality in HealthCare (ACSQHC). Practice level indicators for primary health care specification. Sydney: ACSQHC; 2012.
 Starfield B. Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS Report 2012. Gac Sanit 2012; 26 20–6.
| Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS Report 2012.CrossRef | 22265645PubMed |
 Horvarth J. Review of Medicare Locals: report to the Minister of Health and Sport. Canberra: Australian Government; 2014.
 Scott A, Sivey P, Ait Ouakrim D, Willenberg L, Naccarella L, Furler J, Young D. The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database Syst Rev 2011; 9 CD008451
| 21901722PubMed |
 Australian National Audit Office. Practice incentives program. Canberra: Commonwealth of Australia, 2015. Available at: http://anao.gov.au/Publications/Audit-Reports/2010-2011/Practice-Incentives-Program/Audit-brochure [verified 17 January 2014].
 Oliver-Baxter J, Brown L, Raven M, Bywood P. Quality improvement financial incentives for general practitioners. Adelaide: Primary Health Care Research & Information Service; 2014.
 Greene J. An examination of pay-for-performance in general practice in Australia. Health Serv Res 2013; 48 1415–32.
| An examination of pay-for-performance in general practice in Australia.CrossRef | 23350933PubMed |
 Kontopantelis E, Reeves D, Valderas JM, Campbell S, Doran T. Recorded quality of primary care for patients with diabetes in England before and after the introduction of a financial incentive scheme: a longitudinal observational study. BMJ Qual Saf 2013; 22 53–64.
| Recorded quality of primary care for patients with diabetes in England before and after the introduction of a financial incentive scheme: a longitudinal observational study.CrossRef | 22918988PubMed |
 Bardach NS, Wang JJ, De Leon SF, Shih SC, Boscardin J, Goldman LE, Dudley A. Effect of pay-for-performance incentives on quality of care in small practices with electronic health records: a randomized trial. JAMA 2013; 310 1051–9.
| Effect of pay-for-performance incentives on quality of care in small practices with electronic health records: a randomized trial.CrossRef | 1:CAS:528:DC%2BC3sXhsFGnu7zJ&md5=eaa49ccd307d9f9e025255af5ca4185aCAS | 24026600PubMed |
 Unützer J, Chan YF, Hafer E, Knaster J, Shields A, Powers D, Veith RC. Quality improvement with pay-for-performance incentives in integrated behavioral health care. Am J Public Health 2012; 102 e41–5.
| Quality improvement with pay-for-performance incentives in integrated behavioral health care.CrossRef | 22515849PubMed |
 Hurley J, DeCicca P, Li J, Buckley G. The response of Ontario primary care physicians to pay-for-performance incentives. Toronto: McMaster University; 2011.
 Centers of Disease Control and Prevention Strategies for reducing morbidity and mortality from diabetes through health-care system interventions and diabetes self-management education in community settings. A report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep 2001; 50 1–15.
| 18634202PubMed |
 Capewell S, Ford ES, Croft JB, Critchley JA, Greenlund KJ, Labarthe DR. Cardiovascular risk factor trends and potential for reducing coronary heart disease mortality in the United States of America. Bulletin WHO 2010; 88 120–30.
| Cardiovascular risk factor trends and potential for reducing coronary heart disease mortality in the United States of America.CrossRef |
 Russell L, Dawda P. Lessons for the Australian healthcare system from the Berwick report. Aust Health Rev 2014; 38 106–8.
| Lessons for the Australian healthcare system from the Berwick report.CrossRef | 24331177PubMed |
 Tinetti ME, Fried TR, Boyd CM. Designing health care for the most common chronic condition: multimorbidity. JAMA 2012; 307 2493–4.
| Designing health care for the most common chronic condition: multimorbidity.CrossRef | 1:CAS:528:DC%2BC38XhtVCkurfJ&md5=ff7e35d5c4524e8b957aefa8f4179bbdCAS | 22797447PubMed |
 Pearce C, Shearer M, Gardner K, Kelly J. A division’s worth of data. Aust Fam Physician 2011; 40 167–70.
| 21597524PubMed |
 Pearce C, Shearer M, Gardner K, Kelly J, Xu TB. GP networks as enablers of quality of care: Implementing a practice engagement framework in a general practice network. Aust J Primary Health 2012; 18 101–4.
| GP networks as enablers of quality of care: Implementing a practice engagement framework in a general practice network.CrossRef |
 Porter ME. What is value in health care? N Engl J Med 2010; 363 2477–81.
| What is value in health care?CrossRef | 1:CAS:528:DC%2BC3cXhs1Whs7nK&md5=7e37b195a69c9688e7ebb4e10ff52125CAS | 21142528PubMed |
 McDonald J, Harris MF, Cumming J, Davies GP, Burns P. The implementation and impact of different funding initiatives on access to multidisciplinary primary health care and policy implications. Med J Aust 2008; 188 S69–S72.
| 18429741PubMed |
 Smith J, NHS Alliance, NHS Confederation, Royal College of General Practitioners. Giving GPs budgets for commissioning: what needs to be done? London: Nuffield Trust for Research and Policy Studies in Health Services; 2010.
 Ham CJ. GP budget holding: lessons from across the pond and from the NHS. Birmingham: Health Services Management Centre, University of Birmingham; 2010.
 Dawda P, Gardner K, Parkinson A, Yen L, Wells L, Findlay T, Van Weel C. Implementation adviser: clinical leadership embedded within a PHCO. In: Proceedings of the 2015 Primary Health Care Research Conference, 31 July 2015, Adelaide. Adelaide: Primary Health Care Research & Information Service; 2015. Available at: http://www.phcris.org.au/resources/item.php?id=8043&spindex=3 [verified 13 March 2016].
 National Health Service. CCG outcomes indicator set. 2014. Available at: http://www.england.nhs.uk/ccg-ois/ [verified 15 March 2015].
 Ministry of Health. PHO performance programme and transition to the integrated performance and incentive framework. 2014. Available at: http://www.health.govt.nz/our-work/primary-health-care/primary-health-care-subsidies-and-services/pho-performance-programme-and-transition-integrated-performance-and-incentive-framework [verified 4 March 2015].
 Solberg LI, Mosser G, McDonald S. The three faces of performance measurement: improvement, accountability and research. Jt Comm J Qual Improv 1997; 23 135–47.
| 1:STN:280:DyaK2s3lslCqtg%3D%3D&md5=6e2cd05f188f6cf74607411689f05411CAS | 9103968PubMed |
 Naylor C, Curry N, Holder H, Ross S, Marshall L, Tait E. Clinical commissioning groups: supporting improvement in general practice? London: The King’s Fund and Nuffield Trust; 2013.
 Goodyear-Smith F, Gauld R, Cumming J, O’Keefe B, Pert H, McCormack P. International Learning on Increasing the Value and Effectiveness of Primary Care (I LIVE PC) New Zealand. J Am Board Fam Med 2012; 25 S39–44.
| International Learning on Increasing the Value and Effectiveness of Primary Care (I LIVE PC) New Zealand.CrossRef | 22403250PubMed |
 Shaw EK, Chase SM, Howard J, Nutting PA, Crabtree BF. More black box to explore: how quality improvement collaboratives shape practice change. J Am Board Fam Med 2012; 25 149–57.
| More black box to explore: how quality improvement collaboratives shape practice change.CrossRef | 22403195PubMed |
 Shircore R, Shaw S. Commissioning for values is as important as commissioning for outcomes. Perspect Public Health 2013; 133 26–7.
| Commissioning for values is as important as commissioning for outcomes.CrossRef | 23308005PubMed |
 Gray M. Better value healthcare: the challenge, 2015. Available at: http://www.bvhc.co.uk/thechallenge.html [verified 4 May 2015].
 Martin S, Smith PC. Commissioning health: a comparison of English Primary Care Trusts. Preliminary statistical analysis. London: The Health Foundation; 2010.